The Patient Protection and Affordable Care Act (the ACA, for short) became law with President
Obama’s signature on March 23, 2010. It represents the most significant transformation of the
American health care system since Medicare and Medicaid. It is argued that it will fundamentally
change nearly every aspect of health care, from insurance to the final delivery of care. The length and
complexity of the legislation and divisive and heated debates have led to massive confusion about the
impact of ACA. It also became one of the centerpieces of 2010 congressional campaigns.
Essentials of ACA include: 1) a mandate for individuals and businesses requiring as a matter of law
that nearly every American have an approved level of health insurance or pay a penalty; 2) a system
of federal subsidies to completely or partially pay for the now required health insurance for about
34 million Americans who are currently uninsured – subsidized through Medicaid and exchanges; 3)
extensive new requirements on the health insurance industry; and 4) numerous regulations on the
practice of medicine.
The act is divided into 10 titles. It contains provisions that went into effect starting on June 21, 2010,
with the majority of provisions going into effect in 2014 and later.
The perceived major impact on practicing physicians in the ACA is related to growing regulatory
authority with the Independent Payment Advisory Board (IPAB) and the Patient Centered Outcomes
Research Institute (PCORI). In addition to these specifics is a growth of the regulatory regime in
association with further discounts in physician reimbursement. With regards to cost controls and
projections, many believe that the ACA does not fix the finances of our health care system – neither
public nor private. It has been suggested that the Congressional Budget Office (CBO) and the
administration have used creative accounting to arrive at an alleged deficit reduction; however, if
everything is included appropriately and accounted for, we will be facing a significant increase in
deficits rather than a reduction.
When posed as a global question, polls suggest that public opinion continues to be against the health
insurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing health
care reform. However, advocates of the repeal of health care reform have been criticized for not providing
a meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vague
arguments against the ACA without addressing core issues embedded in health care reform.
It is the opinion of the authors that while some parts of the ACA may be reformed, it is unlikely to
be repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult to
repeal.
In this manuscript, we look at reducing the regulatory burden on the public and providers and elimination
of IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs with
appropriate negotiating capacity for Medicare, and consequently for other insurers.
Key words: Affordable Care Act, health care costs, health care regulation, health care reform,
Patient Centered Outcomes Research Institute, health exchanges, health care subsidies, health
insurance premiums, uninsured, Medicare, cost control
What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms
