by S. Todd Stolp MD
©July 2012
People often comment to front line health care providers that they could not imagine becoming desensitized to the sight of blood and gore in the way that doctors and other health care providers seem to become desensitized during training. But for me, I cannot imagine having the intestinal fortitude that it must take for legislators to escort new legislation through the messy process of becoming law. No example of this surrealistic process is more apt than the tortuous path that has been foisted upon the Affordable Care Act. But now it is time for all of us to sponge the wound and take care of the patient.
Obviously, there are many explanations why this landmark health reform was confronted by such a mournful battlefield. Political diversions from all directions are certainly partly responsible. The fact that virtually everybody has a personal relationship with health care is another contributing factor. But there is another contributor which, unlike many of the other issues, we can do something about. That is a lack of public understanding about the details of the Affordable Care Act itself. It is perhaps past time that a physical examination of this law needs to be made by every American.
One point is worth mentioning before putting the Affordable Care Act on the examination table. By searching the internet with “the healthcare law and you,” (or by going to healthcare.gov) you can review the actual text of the law. You will find that in the legislative version each page has only slightly more words than a fortune cookie. Thus the entire act comes to 2407 pages. However, in the “consolidated version,” the act fits just fine on 906 pages. The first ten pages of the 906 pages of the language of the law will give you a look at the table of contents. By scanning over these first ten pages you will actually get a pretty good overview of the content of the entire act without being intimidated by the common belief that the law is “too complex to understand.”
The Affordable Care Act consists of ten Titles, each of which is listed in the table of contents broken down into Subtitles and Sections that address different aspects of each Title. While the language is not designed for every person’s palate unless you are familiar with legislative lingo, the healthcare.gov website offers a more user-friendly way to peruse the contents of the law.
Title I tackles multiple obstacles encountered by people trying to qualify for affordable health insurance. Measures include a phased-in schedule for eliminating pre-existing conditions as a reason for insurance disqualification, incentives to assure that each person either seeks personal insurance coverage or contributes to the overall health coverage for the community (AKA “The Mandate”) and extending coverage to youth on their parents insurance plans up to 26 years of age.
Title II Expands and refines the role of safety-net services like Medi-Cal, while Title III addresses efficiency and quality in the healthcare system. Title III also fills the so-called “doughnut-hole” in coverage for prescription medications in Medicare for seniors. Title IV provides for an expansion of prevention in our communities and in our health care system to capture savings that until now have been limited to pilot programs. Title V seeks to bring more qualified and well-trained individuals into the healthcare workforce. Title VI assures that the public will have access to their own healthcare information and addresses abuses within the system that divert dollars away from actual patient care. Title VII endeavors to fund new and promising treatments and incorporates discounts that are used in the private healthcare industry that have not been adequately employed to save taxpayer money in public systems. Title VIII prepares for the cohort of Baby Boomers who will be moving towards senior care in the next few decades by expanding Long Term Care options. Title IX describes a number of cost saving measures and imposes some requirements upon hospitals that have been enjoying the benefit of tax deductions. Finally, Title X addresses the needs of Native Americans in keeping with old agreements and cleans up language scattered throughout other portions of the law.
There you have it. Learn about the new health care law that has withstood judicial review. Talk about it and express your opinion about the parts you support and the parts you do not. But please recognize that our patient needs our attention, and it is time that we endeavor to first clearly understand and then contribute to improve the status quo.