Will The Affordable Care Act Ever Achieve Its Lofty Goal?

On June 28, 2012, the United States Supreme Court upheld the 2010 Patient Protection and Affordable Care Act (PPACA), setting into motion changes that will transform the way in which healthcare services are reimbursed and delivered. There are undoubtedly some positive changes that will come about thanks to the Act. Americans with pre-existing medical conditions can no longer be discriminated against. Younger adults can stay on their parents' medical insurance until they are 26-years-old, which could drastically ease the burden of college students entering a harsh economy and a competitive job landscape. Health insurance exchanges will assist those who are not offered medical insurance through their employer.

However, the PPACA does not come without complications. Here are some of the concerns that political analysts and healthcare professionals have raised.

Costs

Throughout the long and arduous process of having the PPACA passed, President Obama repeatedly assured the American public that the Act would A) make healthcare more affordable and B) not be a tax. Of course, now we know that the Act was only able to be upheld as a tax and, as for making healthcare more affordable, Forbes recently addressed this issue by calling to attention a selection from the Senate’s version of the bill:

Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

This has provided a soft target for critics. “Two thousand seventy-four pages and trillions of dollars later,” Mitch McConnell, the Senate Minority Leader, said recently, “this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs.”

The core thinking behind the program is simplistic, if more people are covered for more services, spending will go down. Unfortunately, current research shows that those with healthcare coverage spend approximately twice as much as those without it . With approximately 32 million previously uninsured Americans set to gain comprehensive medical insurance, there could be a massive spike in spending. Will this increase result in eventual cuts in care and services?

Care

With so many people set to enter the market, the issue of quality of care becomes one of concern. The United States already suffers from a shortage of primary care doctors, and providers are already trying to see as many patients as possible to maximize profits. This problem becomes further complicated by an attempt to pay doctors for their performance. Newly insured patients—which will include those who were previously denied coverage because of poor health or preexisting conditions—will be extremely hard to accurately monitor.

From a provider standpoint, how is quality going to be measured? Will emphasis be placed on the outcomes? Consider the following scenario: two doctors provide care to a similar set of patients—same demographic, age, etc. Both doctors provide the exact same care to the set of patients; however, one set of patients struggles to adhere to medications. Although both doctors have provided the proper care, one stands to be penalized because of medication adherence, which he/she cannot control. This leads to another subset of problems in terms of providers needing to spend more time (of which they already have a shortage) examining patient histories, so that they might select patients with better histories of medication adherence. This situation complicates care for patients who most likely need it the most; problematic patients who require more time and patience are the ones that doctors will have the hardest time being reimbursed for.

Confusion

Even before the landmark decision by the Supreme Court, the United States healthcare system was a confusing place with misplaced incentives. As Merrill Matthews recently wrote, “Doctors don’t know who their real customer is: the patient getting care or the government, employer, or insurer paying for it. The situation often pits healthcare providers against patients who want everything and the payers who want to limit costs. It’s a no-win situation of perverse economic incentives, and ObamaCare only exacerbates the problem.”

The primary goal of the PPACA is to extend healthcare coverage to all Americans while lowering Medicare spending; however, it is difficult to envision this outcome with the Act in its current form. That is not to say that these issues will not be addressed over the coming months. The PPACA is far from the first flawed Act in American politics. If lawmakers refocus on the goal at hand and work together to achieve it, then there stands to be significant (and necessary) improvements on the way.