The Affordable Care Act: Implications for Clinical Practice and Research

In "What Does the Affordable Care Act Actually Do?," presented by Ivor Douglas, MD, Associate Professor, University of Colorado Denver, Chief, Pulmonary Sciences and Critical Care Medicine Director, Medical Intensive Care, Denver Health Medical Center, at the ATS 2013 International Conference, Dr Douglas noted that fundamental issues driving the Affordable Care Act (ACA) include access, quality, and cost. Currently, statistics show between 40 and 50 million Americans remain uninsured. Dr Douglas said that it's not just patients who are frustrated, but the providers and hospitals. With that in mind, healthcare reform is intended to increase access for 310 million people, reduce healthcare costs, and improve quality in various aspects including extending life expectancy, lowering infant mortality rates, and lowering chronic disease by age. The reform is also slated to expand primary care and offer more preventive services.

Dr Douglas said that while various ACA initiatives have been in place since 2010, the bulk of those efforts will be employed within the next 10 years. In fact, he argues we are on the cusp of a few major components of implementation including state insurance exchanges, essential health benefits packages, and the individual mandate to purchase health insurance. Dr Douglas said one the most significant and largest changes, however, will be Medicaid expansion as it an important factor for uninsured Americans. In the ACA era, Medicare is projected to cover 50 million people aged 65 years and older, as well as younger adults with disabilities.

Dr Colin Cooke from the Michigan Center for Integrative Research in Critical Care, followed Dr Douglas in questioning, "Will Covering More People Remedy Disparities in Access and Outcomes of Care?" Of those millions of uninsured Americans, most are in the low to moderate income bracket, which makes them unable to afford insurance while also being ineligible for public programs. A lack of health insurance can mean reduced access to care, greater economic hardship, and negative health outcomes. Subsequently, Dr Cooke asked, "Does providing insurance to an uninsured individual improve these outcomes?" One study of a Medicaid program in Oregon definitively answered yes. It showed that when provided insurance, patients were protected from "catastrophic financial loss," saw an improvement in quality of life as well as peace of mind, and increased their access to beneficial health services. Nevertheless, Dr Cooke notes while it is likely the ACA will improve health outcomes, longer-term data is needed, and the overall improvement may not be as nearly much as anticipated. After all, insurance is just one small factor that contributes to efficient healthcare outcomes.

In "How Will the ACA Impact the Daily Lives of Clinicians in Pulmonary Critical Care, and Sleep Medicine: Lessons from Abroad," Dr Robert Fowler, Sunnybrook Hospital, University of Toronto, discussed that healthcare and critical care in the United States costs $2.7 trillion each year. This is significantly higher than most other countries, as various data shows the US consistently has higher costs for drugs, higher costs for diagnostic imagining, and higher spending in physicians' incomes. As Dr Cooke discussed the importance of insurance coverage, Dr Fowler agreed that insurance is a crucial factor in healthcare. This is because uninsured patients are much less likely than those with private/commercial insurance to receive critical care services. However, the uninsured also may be more likely to require critical care because they do not seek professional advice before health situations are serious in nature. Overall, Dr Fowler says greater expenditures do not equate to quality healthcare. Improving access to healthcare for greater coverage will likely be beneficial for health. While many Americans remain uninsured, increasing coverage may not guarantee increased quality of care across the population.