Not So Affordable Health Care
Introduction
The Patient Protection and Affordable Care Act (PPACA or ACA) is legislation that was passed by Congress and signed into law on March 23, 2010. The Act is aimed to reform the current healthcare system in the United States, allowing all citizens to have health insurance regardless of their previous medical history or current financial position. In addition, the Act aims to provide universal, high-quality healthcare at a low cost. Nearly 50 million citizens are currently uninsured, but with the new legislation, around 30 million Americans will gain coverage. While this Act will lead to a healthier population and allow for more people to have the coverage they need, PPACA is not going to improve the already damaged healthcare system in place. Overall, The Patient Protection and Affordable Care Act is going to put a larger strain on the healthcare system as well as medical professionals and medical institutes, decreasing the quality of the healthcare provided.
This video explains the basics of the healthcare reform.
A Shortage of Healthcare Professionals
Amy Anderson, author of The Impact of the Affordable Care Act on the Health Care Workforce, wrote that “[d]espite the best efforts of the medical professionals and educators to increase the workforce over the past few years, shortages are projected in every health care profession”. The shortages of health care professionals in the workplace results from the 30 million newly insured consumers, who will need primary physicians and medical attention. The healthcare system will not be able to accommodate 30 million new patients. Amy Anderson predicts that several negative impacts will follow: “patients will be facing increasing wait times, limited access to providers, [and] shortened time with caregivers.” Furthermore, the wait time for surgeries will increase and the medical exams at the doctor’s office will be rushed because the physician will have two to three times as many patients to fit in as he or she did previously. These adverse effects will sum to a diminishing quality of healthcare. David M. Pariser, the author of Ethical Considerations in the health care reform, used an insightful analogy for the new consumers entering the medical field:
“ACA is giving more people health insurance, but that does not mean that they are going to get health care. This ‘promise’ of health care without the adequate infrastructure to develop it will raise expectations that cannot be met and is ethically unjust. We are giving more people tickets to the health care bus, but all the buses are currently filled and we are not making any new buses. The only logical outcome is that more people will be waiting for the bus and when they get on, they will have to share a seat. Waiting times for care will increase, care will need to be rationed, and overall quality will decrease.”
This metaphor does a great job of illustrating what it will be like for the new recipients of the government subsides because there are simply not enough physicians to fill the needs of consumers, resulting in a poor healthcare system.
Nurses and Physician Assistants
As the shortage of physicians continues to increase, there will be an increased need for physician’s assistants and nurse practitioners who can assist the physicians with simple matters, such as a checkup or basic injections. Because the schooling for these healthcare professionals is not as lengthy as that of a physician, they will be in high demand. These young adults can get through school and start making contributions to the demand for medical professionals sooner than a doctor could. Despite this increased demand, there are many parts of the ACA that hinder their practice. If Nurse Practitioners and Physician Assistants were given more independence and training, they could begin to fill some of the gaps in the workplace. Although a Nurse Practitioner is capable of many medical attributes, and can help fill the need for medical professionals, they cannot replace the expertise and care of a well-trained physician. As a result, although they will aid in the shortage, this will not completely fix the demand for physicians.
The ACA limits nurses and PA’s in several different ways. According to the Affordable Care Act: Overview and Implications for Advancing Nursing, written by Deborah Vincent and Pamela Reed, the Scope of Practice Laws differ from state to state and put different regulations on Nurse Practitioners. For example, in some states they cannot prescribe medicine, but in other states they can. In addition, in some states, N.P.s are required by Medicare regulations to collaborate with a physician, again blocking their growth and independence. Also, the reimbursement rates are much lower than doctors’ for Medicare, so they are not compensated as much as a doctor. As a result, these barriers and ones like them are keeping Nurse Practitioners and Physician Assistants from growing and becoming more beneficial in the workplace. If they could further their skills, they would be able to help improve the quality of the healthcare system.
WWAMI Program
The Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program is a 42 year old program known for their success in rural medical training. In the article The WWAMI Program as a Case Study, Jones et al. discuss the implications that the Affordable Care Act brings upon rural programs such as theirs. The goals of the company are to “expand medical education, offer accessible training for health professionals, increase the number of primary care physicians, and address physician maldistribution.” WWAMI works to educate prospective healthcare professionals and place them in a residency program where they can learn the necessary skills to become a physician. Due to the ACA, there will be a shortage of physicians which will lead to physicians leaving rural areas for more densely populated centers, further damaging the quality of healthcare in rural and underpopulated areas. The authors state that “medical schools have been expanding their class sizes to meet the need” of the new consumers, although it still is not enough. Once students have completed their Graduate Medical Education, there are not enough residency positions available for the graduates. No matter how hard colleges try to push students through med-school, it still takes about a decade or more to be properly certified. Again, the lack of properly trained healthcare professionals will lead to a unsatisfactory healthcare system.
Payment of Doctors
Under the new legislation, physicians will no longer be compensated based on the fee-for-service method but rather on a prepaid or global payment system. While there are clear flaws in the fee-for-service method currently in place, the method of compensation suggested in the Affordable Care Act presents moral dilemmas as well. Although, the physicians are given an incentive to keep their costs of medical care low in order to reduce healthcare costs (unlike the fee-for-service method), this new method will give physicians “financial incentives to withhold or delay diagnostic or therapeutic procedures.” Furthermore, “there will be incentive not to prescribe expensive drugs or treatments.” On the other hand, in the fee-for-service method, the physician is paid for every treatment given, individually, giving the doctor more incentive to carry out more treatments. According to Praiser:
“Quality of care will suffer because providers will have financial incentives to withhold or delay diagnostic or therapeutic procedures, and there will be incentive not to prescribe expensive drugs or treatments. The sickest patients will suffer the most because providers may be reluctant to accept them because of the severity of their disease. The increased health care resources they will need may negatively affect the reimbursement to the provider if those payments are based on the ‘average’ or ‘typical’ case.”
Therefore, if one is very ill, he or she will be “put on the back-burner” because their treatment is just expensive and will result in penalties for the physician. Because pay by performance increases the likelihood of denied treatments, it also diminishes the quality of the American Healthcare System. Even worse, physicians may avoid treatments or screenings that a patient may need. Although the fee-for-service method is flawed, is this any better?
Academic Medical Centers
The Affordable Care Act and Academic Medical Centers, written by Taylor and Clinchy, expresses the problems that will arise for Academic Medical Centers (AMC) as a result of the Affordable Care Act. Of the approximately 30 million citizen’s now acquiring health coverage, about 16 million of those citizens will be covered through Medicaid. Because, Medicaid does not have a great reimbursement program, most doctors will turn away patients covered by Medicaid. For the next two years, the doctors will receive a 100% reimbursement from Medicaid at 2013 and 2014 rates as well as 10% increase in pay from Medicare for the next 5 years. Academic Medical centers work with graduate students to get them into residency programs and have proper training. Without the proper funding from the government it will make it harder for these AMCs to provide these opportunities, even with the shortage of physicians. Taylor and Clinchy write that “Congress is currently discussing cuts to medical education as part of its deficit reduction plan.” If congress goes through with making cuts to medical education, it will be even harder for the country to have enough physicians for the demand of consumers and continuing to diminish the quality of healthcare.
If you did not know, MCV is one of the top Academic Medical Centers in the country, so this really hits home for us. MCV provides some of the best doctors in its field, and MCV like other Academic Medical Centers, will have to take a cut to how many residents they can take on in their program, despite the act that class sizes are increasing. Not only does MCV produce excellent doctors, but we also have a top notch research program, like the Oncology department for example. The brightest students are doing research, trying to come up with innovative, new technology and advancements, and now, there is not enough money in the budget for things like which increase future quality of healthcare. Cuts have to be made to healthcare costs in order to provide affordable care.
The Ethics
David Praiser wrote a very interesting article, showing the pros and cons of some of the arguments that come about with ACA. Some of the ethical questions are very interesting and really make you think. For example, is it ethical to mandate that citizens purchase healthcare? Well, the US Constitution says that the government must provide general welfare for the public. The Constitution does not state though that it is required for each individual to purchase health care or else he or she will be penalized. In addition, is right that the government is giving physician’s incentives to not provide hefty treatments that would be expensive, but save lives? Amy Anderson writes, “Of course doctors, nurses and other health care professionals want to help people in need, but the sheer logistics of expanded care delivery, the current and growing personnel and limited resources will certainly undercut the good intentions of the policymakers who crafted the national law.” Anderson is saying that while medical providers want to do what is best for the patient, they also have to look out for themselves. It really is not fair because the government is putting physicians in a position to make decisions they should not have to make.
Conclusion
Overall, all the subtopics tie together and show how widely this legislation affects people. Personally, I believe that The Patient Protection and Affordable Care Act is a great idea, and that if it were tweaked in quite a few areas then it could provide a better health care system for Americans. But as it is, the PPACA will not hold up to the American standard of health care. Instead, I would propose implementing another form of government aid that is not mandated. That way, it would provide another option for people to get coverage. In America we try to provide for the lower class and help them as much as possible. We provide free health clinics that you can go to, no questions asked. Even people who are illegally in the country are able to go to these clinics get the medical attention they need. It is not a perfect system by any means, but it is a start. The Affordable Care Act is a step in the right direction, but a universal health care system simply is not the answer. Too many parts of the act are invasive and control too much of the medical field, impeding doctors from healing patients and do their job to the best of their ability. Furthermore, the Affordable Care Act has adverse affects for doctors, nurses, hospitals and other medical professionals. It is not only making their job harder and more stressful, but they no longer will be properly compensated. As a result, we will be faced with an even more fragile healthcare system that could eventually collapse.
REFERENCES
Allen, Suzanne M., et al. “Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment with the Affordable Care Act: The WWAMI Program as a Case Study.” Academic medicine : journal of the Association of American Medical Colleges 88.12 (2013): 1862. . Primo.
Anderson, Amy. “The Impact of the Affordable Care Act on the Health Care Workforce.” Backgrounder (n.d.): n. pag. The Heritage Foundation, 03 Mar. 2014. Web. 30 July 2014. <http://thf_media.s3.amazonaws.com/2014/pdf/BG2887.pdf>.
Mehta, Neerav, and Saurabh Jha. “The Patient Protection and Affordable Care Act in a Nutshell.” Journal of the American College of Radiology 9.12 (2012): 877-80. . Primo.
Pariser, David M. “Ethical Considerations in Health Care Reform: Pros and Cons of the Affordable Care Act.” Clinics in dermatology 30.2 (2012): 151-5. . Primo.
Rosenbaum, Sara. “The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice.” Public health reports (Washington, D.C.: 1974) 126.1 (2011): 130. . Primo.
Taylor, Ian L., and Ross McVicker Clinchy. “The Affordable Care Act and Academic Medical Centers.” Clinical Gastroenterology and Hepatology 10.8 (2012): 828-30. . Primo.
US News. U.S.News & World Report, n.d. Web. 30 July 2014. <http://health.usnews.com/best-hospitals/area/va/virginia-commonwealth-university-medical-center-6340860>.
Vincent, Deborah, and Pamela G. Reed. “Affordable Care Act.” Nursing science quarterly 27.3 (2014): 254-9. . Primo.
WE DID IT GUYS! I enjoyed reading everybody’s work these eight weeks and working with you all. I hope everyone has a great rest of their summer and is getting geared up for another great Fall Semester!!!!! GO RAMS
