by Laura Carabello, Executive Editor and Publisher, Medical Travel Today With President Barack Obama reaffirmed for four more years, the medical travel community can expect an uptick of interest and support from American employers and consumers. The fate of the Affordable Care Act (ACA) is now more secure. Since it is likely to remain in place, the projected volume of uninsured and underinsured Americans is expected to drop, precipitously. This opens opportunities for payers, insurers and health plans to offer some type of medical tourism benefit option that helps to achieve savings for all stakeholders. US domestic medical travel is expected to grow, especially with the commitment of companies such as Wal-Mart, Lowe’s and PepsiCo already setting the trend. Look to the expansion of self-insurance, particularly among middle market employers who are seeking more value for their benefit plans. Medical travel programs – both domestic and international – are attractive options that offer effective solutions for cost control, particularly when combined with StopLoss insurance to alleviate the risks associated with catastrophic claims. In this new healthcare paradigm, there is a greater focus around provider accountability, with a proliferation of Accountable Care Organizations (ACOs) throughout the US that are directly contracting with employers. Physicians participating in ACOs that are independent of hospital ownership may be more willing to consider the suggestion of a medical travel option for patients as a means of generating cost savings that can then be shared among the providers. The ACA is expected to compress access to primary care physicians (PCPs), evidenced by the experience in states such as Massachusetts where the average wait time for an appointment can be as long as two months. As a result, the practice of “Concierge Medicine” – also known as direct care where a patient pays an annual fee or retainer to the primary care physician – will expand as consumers seek better access to their PCPs. Concierge physicians do not necessarily have allegiance to a particular US hospital, and can opt to refer patients virtually anywhere in the world for surgery or other procedures. Estimates of US doctors now practicing concierge medicine range from fewer than <800 to 5,000+. As the new landscape evolves, there will be a need to provide a seamless transition for workers moving from employer-sponsored insurance (ESI) to public- or private-insurance exchanges or other coverage options. Benefits payers must develop a better understanding of their customers and new capabilities to serve them, setting the stage for the introduction of medical travel programs that will enhance the product offering and provide a robust menu of quality, cost-saving options. Healthcare reform will do little to control the problem of spiraling costs: Healthcare reform was initially conceived by the Obama team as a solution to the impending insolvency of the Medicare program in 2018 and as a means of expanding coverage to the uninsured. It has morphed into legislation primarily directed to expanding coverage for the uninsured, but is not expected to control costs. The true causes of our system’s escalating healthcare costs have not been addressed directly by this legislation. Conversely, the cost of care outside the US appears to remain stable, with savings of 50 to 80 percent on some procedures. The phenomenon of US domestic medical travel is gaining traction because US Centers of Excellence now see an opportunity to attract patients wherever they live. Medical travel will continue to present less expensive options for quality care, and the re-election of Obama may well provide the impetus for jump-starting the process.