Most mornings, I opt to take the red line commuter train from my apartment in Bethesda, Maryland to my hospital in Washington, DC. Despite the costly two-way fare, it’s a worthwhile journey because it’s a chance to observe the various other commuters making their way to all sorts of destinations. It’s a people watcher’s dream! Some look dressed to impress on Capitol Hill or in corporate offices. Others look as though they are going home after a long overnight shift. There are those happy to have found a warm train car in which to rest, CEOs studying their daily planners, and a mixture of everyone in between. No other place in DC will one find the diversity of people in a metro train car except in one location: the health care system.
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The ACA was the first major health related legislation in decades with the overall goal of expanding coverage and improving the quality of our health care delivery systems. It’s a remarkable point to consider that all those I encounter on my daily metro commute, including health professionals like myself, are significantly impacted by this one piece of legislation.
As a medical resident in Washington DC, I am starting to see the impact of the ACA on my patients and practice. Some of my physician colleagues express concerns, others are in support. We all have questions.
“How will the ACA affect our relationship with patients?” we wonder.
Will increased volumes and decreased reimbursements make it difficult to provide care? Time will tell.
Prior to the enactment of the ACA, patients were on the border between not qualifying for Medicaid and not being able to afford private insurance. Many were on the cusp of bankruptcy due to medical expenses. Through the ACA, many states will expand Medicaid coverage to 138 percent of the federal poverty level. Even in some states, those in lower income brackets, there will be an opportunity to obtain waivers to buy private health insurance. Those obtaining insurance through the “marketplace” will have assistance to afford premiums for health insurance, ensuring that millions of Americans will finally have affordable and meaningful coverage.
In addition, the ACA establishes a patients’ bill of rights. Caps on out-of-pocket expenditure assist so patients are not drowning in health care related debt. Achieving appropriate coverage means no more straddling the border between financial stability and instability and can help to ensure access to care before disease states result in poor outcomes. For me, these significant changes mean I have the ability to provide better care by reaching patients. It means I’ll have better followup.
The net result: I am able to do my job better.
While the ACA is a step in the right direction, there are many issues that did not make the final bill that I believe could improve the health of my patients, our delivery systems, and reduce costs. Communication between electronic medical records at different institutions needs to be mandated. The inability to easily obtain medical information from outside hospitals has resulted in unnecessary repeated tests, resource waste, and complications for patients. More comprehensive language and funding in the bill should have been allocated toward combating problems like obesity through exercise and nutritional initiatives for patients. Given our aging population, additional funding and services for my elderly patients would also help me do my job better and allow me to provide the services my patients really need.
Despite the limits of the Affordable Care Act, it is a tremendous step forward towards achieving a strong health delivery system. When riding the metro home after seeing patients in my clinic, I feel proud that we were able to pass the ACA and, in one way or another, improve the health care experience of each and every passenger. We haven’t, however, reached our destination. The journey must continue.
Meena Hasan is an internal medicine resident and on staff, ABC News Medical Unit. She blogs at Daily Dose MD.
