Affordable Care Act Primer for Premeds (Part 4)

I have spent more time on this four-part Primer than I originally intended. Really, I don't know how well something as massive as the Patient Protection and Affordable Care Act can be summarized  in just a few pages. Hopefully, you'll walk away feeling a little more knowledgable on the subject. Maybe you'll even learn something that might surprise your interviewer (though he/she might think you are lying--actually, the thing is so massive, they probably would believe what you are saying is true even if you were lying). 

Title V: Health Care Workforce

This is the part premeds are most concerned with, right? It’s been asserted that the Act will make things better for primary care providers and encourage more students to enter this specialty. Title V directs funds to federally-qualified health centers (FQHCs), the National Health Service Corps, and Community Health Centers. It also increases loan repayment amounts to qualified health professionals. Funds are also set aside to increase graduate nurse education training. (Leadership of nursing associations has been very successful in promoting the Doctor of Nursing Practice as the answer to our primary care shortage.)

Someone told me that more doctors will go into primary care due to the Act redistributing primary care residencies. She probably didn’t realize that primary care residencies have more unfilled positions than any other specialty. Shifting those spots to rural locations probably wouldn’t make them more attractive.

Title VI: Transparency and Program Integrity

This section of the Affordable Care Act puts safeguards in place to keep providers honest and patients safe. Gifts made to physicians and hospitals valued at more than $10 must be publically reported. Though few providers would say that they have ever been influenced by industry gifts, there have been studies to prove otherwise. Human nature makes us friendly to those who have been friendly to us.

Title VII: Improving Access to Innovative Medical Therapies

Have you heard the grievances against Monsanto? Here’s a one-sentence summary: They’ve taken something in nature, patented it, and are now licensed as gods. This section of the ACA puts a path in place for the FDA to license biological products. There are now like other medications with a 12-year exclusivity period before generics can be made. If, by some miracle, I knew that I would live to 150, patent law would be an interesting area to study. Alas, life is too short for me to learn the ends-and-outs of this regulation.

This section also gives special price-breaks for certain clinics serving low-income populations.

Title VIII: Community Living Assistance Services and Supports

This section provided a public option for long-term care insurance. It was repealed.

Title IX: Revenue Provisions

You will be delighted to learn that approximately half of the Affordable Care Act is funded. Honestly, I’m not sure what this means. Taxes and penalties enumerated in this section make the Act (more or less) 50% viable. Where the other funds will come from depends on Congress. At a med school interview, I was asked what I think are the implications of the ACA. My response was that either one of two things will happen. As the system gets stretched in a new direction, 1) we pass a breaking point which will revolutionize the way health care is done in this country with a few insurance plans being casualties of the changes or 2) the system will not stretch like we thought and we will experience a correcting recoil that puts us back to where we were five years ago. Not really that prophetic, but that’s how I see it. Either it will give us dramatic changes or it will give us nothing at all.

Title X: Strengthening Quality, Affordable Health Care for All

This section is known as “The Manager’s Amendment.” It provides guidance and regulations for inter-state health insurance exchanges. It also has a seemingly odd tidbit that reaffirms the Second Amendment. “What,” you may ask, “does the Second Amendment have to do with health care?” Some electronic health records prompt providers to ask about gun ownership to “trigger” (I couldn’t resist the pun) a conversation about gun-safety with children in the home. Wellness programs and insurance companies are forbidden from collecting this data, though providers are not prohibited from talking about safety.

Want to Learn More?

If this series of posts wasn’t enough to satisfy your curiosity, you can read more about the Patient Protection and Affordable Care Act on the following websites:
www.healthcare.gov 
www.healthreform.kff.org 
www.healthpolicyproject.org