The Affordable Care Act (ACA) was signed into law almost exactly two years ago last month. As I write, the Supreme Court is hearing arguments that may over turn President Obama’s controversial health care law. Many people, both moderate Republicans and Democrats, don’t like the new bill. Arguments have been made on both sides of the political spectrum that the law did not go far enough (and create a single payer system) or it went too far (and just created more government).
Of course, several lawmakers famously agreed they hadn’t read the long document when they voted pro or con. Multiple articles, books and even YouTube videos have attempted to explain the law, but there are numerous complicated divisions in the document — in fact, there are 10 separate distinct sections, and even more riders and amendments.
The question for the Supreme Court right now is whether the controversial law is unconstitutional. Legal experts debate if the provision requiring Americans to buy health insurance is severable from the bill or if the whole law will be overturned.
Yet, through all this turmoil, what are the implications of the ACA for PAs? PAs were mentioned approximately 41 times in the 907 pages of the bill. Where did we benefit? Where were we left out? What is the future for health care now that the law has been around for two years, and how will our professional lives be affected?
The initial primary impact has been in two arenas, first in grants to education programs to train more PAs, and also in other innovative grants that may include PAs. Spending was nearly immediate, with nearly $40 million in grant funding; most of these grant dollars were part of the Prevention and Public Health Fund, which was part of the ACA law.
Unfortunately PAs were left out of an important provision in the law: money that was earmarked for Electronic Health Records (EHRs) and the evolution of meaningful use in health information technology. The funding was nearly $20 million over 4 years.
Ultimately, the impact of ACA might be indirectly negative from a public relations viewpoint. Physicians surveyed last year by the Medicus Firm (a national physician recruiting firm who surveyed 1000 physicians on the impact of health reform) displayed an overwhelming lack of confidence in the health care bill for the future of their practices.
Many physicians felt their income would be reduced and their workload increased because of the public option to increase health care insurance to the underserved. Physicians felt they might not be able to continue to practice in this deteriorated health care economic environment. A reduction in the number of practicing physicians in a time when health care access is critical would not necessarily result in advantages to PAs. Although PAs are well poised to shoulder much of the burden of an increased demand for services, the ability to do so without physician partners is not so easily imagined.
How will the bill affect PAs and their ability to see patients in a newly imagined funding environment? Will things be better for PAs in primary care or worse? What about hospital-based PAs and Medicaid/Medicare value based purchasing? With more emphasis on Primary Care Medical Homes (PCMH) and possible Accountable Care Organizations (ACOs), PAs may be well situated to accept and even thrive with these changes.
Recently the Institute of Medicine (IOM) along with Health Resources and Services Administration (HRSA) and the CDC convened a committee of experts to look at ways primary care and public health can integrate and coordinate to improve prevention, primary care health delivery and workforce training. Their conclusions were to strengthen and support primary care systems, develop training grants to help educators focus on preventive training models, and develop the workforce needed to support the integration of primary care and public health.
Certainly the ACA bill’s long-term effect on PAs is not fully evident. PAs have many advantages that will work in our favor. These include flexible specialty choice, relatively lower student loan debt, generalist training models, shorter time span from college to career, high demand for services and well-monitored state practice acts. Our ability to adapt with a changing health care environment will be increasingly important in this tumultuous time.
Jennifer Coombs, PhD, PA-C, is an assistant professor in the University of Utah PA program in Salt Lake City.
This article originally appeared on JAAPA