Patient Protection and Affordable Care Act of 2010: Reforming the Health Care Reform for the New Decade

The Patient Protection and Affordable Care Act (the ACA, for short) became law with PresidentObama’s signature on March 23, 2010. It represents the most significant transformation of theAmerican health care system since Medicare and Medicaid. It is argued that it will fundamentallychange nearly every aspect of health care, from insurance to the final delivery of care. The length andcomplexity of the legislation and divisive and heated debates have led to massive confusion about theimpact 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 lawthat nearly every American have an approved level of health insurance or pay a penalty; 2) a systemof federal subsidies to completely or partially pay for the now required health insurance for about34 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 thepractice 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 regulatoryauthority with the Independent Payment Advisory Board (IPAB) and the Patient Centered OutcomesResearch Institute (PCORI). In addition to these specifics is a growth of the regulatory regime inassociation with further discounts in physician reimbursement. With regards to cost controls andprojections, many believe that the ACA does not fix the finances of our health care system – neitherpublic nor private. It has been suggested that the Congressional Budget Office (CBO) and theadministration have used creative accounting to arrive at an alleged deficit reduction; however, ifeverything is included appropriately and accounted for, we will be facing a significant increase indeficits rather than a reduction.When posed as a global question, polls suggest that public opinion continues to be against the healthinsurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing healthcare reform. However, advocates of the repeal of health care reform have been criticized for not providinga meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vaguearguments 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 tobe repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult torepeal.In this manuscript, we look at reducing the regulatory burden on the public and providers and eliminationof IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs withappropriate 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, healthinsurance premiums, uninsured, Medicare, cost control