The Cost of the Affordable Care Act

Friday, December 28, 2012

In a Washington Post editorial, Kathleen Sebelius, Secretary of the United States Department of Health and Human Services, asserted the Affordable Care Act will make the U.S. health care system stronger than it has ever been, offering more citizens access to the care they need. However, as more deadlines are imposed on physicians, how will these landmark changes affect patient care? 

On March 23, 2010, President Barack Obama signed the Affordable Care Act into law, with specific government-regulated reforms to be met over a four-year period. Following challenges to the law’s constitutionality, the U.S. Supreme Court upheld the Affordable Care Act on June 28, 2012, with a 5–4 vote. This ruling meant health systems and physicians could move forward in ensuring their systems and practices fall within the new guidelines. Nearly 32 million uninsured Americans will now have access to health insurance, regardless of preexisting health conditions, and 2.6 million young adults as old as 26 can be covered by their parents’ health plans.

As more patients are added to the system, however, the need for physicians will also increase. In 2010, the Association of American Medical Colleges (AAMC) predicted there would be a physician shortage even before the Affordable Care Act was signed into law. So, while the new law might equal more access to care, it could mean longer lines for patients and longer days for doctors. According to new projections by the AAMC Center for Workforce Studies, the shortage could grow to 63,000 physicians by 2015, when most of the changes mandated by the Affordable Care Act will be in full effect. These shortages will continue to increase, with the nation lacking an estimated 91,500 physicians in 2020 and 130,600 in 2025.

To help meet increased demand, the Obama Administration has made $168 million available for training nearly 500 new primary care physicians by 2015. However, as Ardis Hoven, M.D., President-Elect of the American Medical Association, pointed out in a July 2012 interview with The Washington Post, the predicted physician shortage has long been an issue and will not be an overnight fix.

Weighing the Benefits

The increase in patients and decrease in medical professionals presents a puzzle for physicians: How will they continue to provide patient-centered care with millions of more patients entering the system?

“I am a physician who abides by the original Oath of Hippocrates,” says Alieta Eck, M.D., a board-certified internal medicine physician and immediate past president of the Association of Physicians and Surgeons. “My loyalty is to my patient and my patient alone.”

Having maintained a private practice since 1988, Dr. Eck is also co-founder of the Zarephath Health Center in Somerset, NJ, which administers care to the poor and uninsured. Rather than adopt changes initiated by the Affordable Care Act, Dr. Eck is maintaining her own model of patient care so she can “continue to see the patients who need me.”

Like Dr. Eck, some physicians wrestle with reconciling health care reform measures and their desire to practice quality medicine in a way that best benefits patients. In May 2012, the Doctor Patient Medical Association Foundation surveyed 699 physicians about their attitudes toward medicine today. When asked if it was becoming “easier or more difficult [to] adhere to a Hippocratic ethic of medicine,” 61% of respondents answered “more difficult.” In the same survey, 90% of physicians indicated the overall path of the U.S. health care system was on the “wrong track.”

According to Thomas H. Lee, M.D., network President of Partners Healthcare System and professor of medicine at Harvard Medical School, changes ushered in by new care models may create difficulties in the short term, however, these challenges are a “logical consequence from the imperative to take care of everyone with limited resources.”

“The Affordable Care Act will add complexity to some aspects of health care as organizations re-tool, and it may increase some costs in the short term,” Dr. Lee wrote in a Harvard Business Review column the day after the U.S. Supreme Court decision. “But ultimately it will improve the quality of patient care and reduce costs as providers and their organizations focus as much on keeping people healthy as they do on healing them when they’re sick. That’s something patients, providers and employers who subsidize care — and want healthy employees — should be happy about.”