The Patient Protection and Affordable Care Act (ACA), informally referred to as
ObamaCare, is a United States federal statute signed into law by President Barack
Obama on March 23, 2010. ACA has substantially changed the landscape of medical
practice in the United States and continues to influence all sectors, in particular evolving
specialties such as interventional pain management. ObamaCare has been signed into
law amidst major political fallouts, has sustained a Supreme Court challenge and
emerged bruised, but still very much alive. While proponents argue that ObamaCare
will provide insurance for almost everyone, with an improvement in the quality of and
reduction in the cost of health care, opponents criticize it as being a massive bureaucracy
laden with penalties and taxes, that will ultimately eliminate personal medicine and
individual practices.
Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional
pain management is unclear. The damage sustained to interventional pain management
and the majority of medicine practices is irreparable. ObamaCare may provide insurance
for all, but with cuts in Medicare to fund ObamaCare, a limited expansion of Medicaid,
the inadequate funding of exchanges, declining employer health insurance coverage
and skyrocketing disability claims, the coverage will be practically nonexistent.
ObamaCare is composed of numerous organizations and bureaucracies charged with
controlling the practice of medicine through the extension of regulations. Apart from
cutting reimbursements and reducing access to interventional pain management,
administration officials are determined to increase the role of midlevel practitioners and
reduce the role of individual physicians by liberalizing the scope of practice regulations
and introducing proposals to reduce medical education and training.
Key words: Patient Protection and Affordable Care Act, ObamaCare, interventional
pain management, Patient-Centered Outcomes Research Institute, Independent
Payment Advisory Board, Centers for Medicare and Medicaid Services, Accountable
Care Organizations, Medicare, Medicaid
The Role of Placebo and Nocebo Effects of Perioperative
Administration of Sedatives and Opioids in
Interventional Pain Management
