Skip to main content

Advertisement

SpringerLink
Log in

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons–Pro and Con Arguments

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or “ObamaCare” for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the “pro” and “con” arguments for the expected and unexpected consequences of the ACA on society and surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Congress.Gov. H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015. 2015 [cited 2015 August 24, 2015]; Available from: https://www.congress.gov/bill/114th-congress/house-bill/1470.

  2. Supreme Court of the United Dates, No. 14–114 King, et al. v. Burwell, Secretary of Health and Human Services, et al. Washington, D.C., 2015. http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf

  3. Cohen, R. and M. Martinez Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January - March 2015, N.C.f.H. Statistics. 2015. Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201508.pdf.

  4. Birkmeyer, J.D., Stukel, T.A., Siewers, A.E., Goodney, P.P., Wennberg, D.E., Lucas, F.L. Surgeon volume and operative mortality in the United States. The New England Journal of Medicine, 2003. 349(22): p. 2117–27.

  5. Blendon, R.J. and J.M. Benson, Voters and the Affordable Care Act in the 2014 election. The New England journal of medicine, 2014. 371(20): p. e31.

    Article  PubMed  Google Scholar 

  6. Gaba, C. Tracking Enrollments for the Affordable Care Act (aka Obamacare). 2015 February 10, 2015; Available from: http://www.acasignups.net/.

  7. Gazelle, G.S., et al., A framework for assessing the value of diagnostic imaging in the era of comparative effectiveness research. Radiology, 2011. 261(3): p. 692–8.

    Article  PubMed  Google Scholar 

  8. Ackerman, T.L. and J. Rosen, Implementation of the ACA: turning federal law into state-level reality. Bulletin of the American College of Surgeons, 2014. 99(5): p. 23–9.

    PubMed  Google Scholar 

  9. Bagley, N., D.K. Jones, and T.S. Jost, Predicting the fallout from King v. Burwell--exchanges and the ACA. The New England journal of medicine, 2015. 372(2): p. 101–4.

    Article  PubMed  Google Scholar 

  10. Cox, C., et al. Analysis of 2015 Premium Changes in the Affordable Care Act's Health Insurance Marketplaces. 2014.

  11. Harvey, H.B., et al., The ephemeral accountable care organization-an unintended consequence of the Medicare shared savings program. Journal of the American College of Radiology : JACR, 2014. 11(2): p. 121–4.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Fisher, E.S. and S.M. Shortell, Accountable care organizations: accountable for what, to whom, and how. JAMA, 2010. 304(15): p. 1715–6.

    Article  CAS  PubMed  Google Scholar 

  13. Hoyt, D., American college of surgeons’ position misrepresented. Health affairs, 2012. 31(10): p. 2353; author reply 2353.

  14. Hoyt, D.B. and D.S. Schneidman, The American College of Surgeons: an enduring commitment to quality and patient care. American journal of surgery, 2015. 209(3): p. 436–41.

    Article  PubMed  Google Scholar 

  15. Marcus, S.G., et al., Staying alive: strategies for accountable health care. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2012. 16(5): p. 927–34.

  16. Stain, S.C., et al., American surgery and the Affordable Care Act. JAMA surgery, 2014. 149(9): p. 984–5.

    Article  PubMed  Google Scholar 

  17. Russell, T.R., That was then, this is now. Journal of the American College of Surgeons, 2011. 213(2): p. 205–11.

    Article  PubMed  Google Scholar 

  18. Patient-Centered Outcomes Research Institute Building a Patient-Centered Research Community, Patient-Centered Outcomes Research Institute 2012 Annual Report. 2012.

  19. Sage, J., The Patient-Centered Outcomes Research Institute. Bulletin of the American College of Surgeons, 2014. 99(10): p. 35–9.

    PubMed  Google Scholar 

  20. Davis, K., et al. 2014 Update Mirror, Mirror On The Wall - How the Performance of the U.S. Health Care System Compares Internationally, pub. no. 1755, T.C. Fund. 2014. May 15, 2015. Available from: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf.

  21. Levin-Scherz, J., One perspective on U.S. Health Care Spending - Premium Price, Poor Performance. Harvard Business Review, 2010: p. 70.

  22. McGinnis, J., P. Williams-Russo, and J. Knickman, The Case For More Active Policy Attention To Health Promotion. Health Affairs, 2002. 21(2): p. 78–93.

    Article  PubMed  Google Scholar 

  23. Schroeder, S., We Can Do Better - Improving the Health of the American People. The New England journal of medicine, 2007. 357: p. 1221–1228.

    Article  CAS  PubMed  Google Scholar 

  24. Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. County Health Care Rankings & Roadmaps: Our Approach. 2014 [cited 2015 May 15, 2015]; Available from: http://www.countyhealthrankings.org/our-approach.

  25. Cutler, D.M., A.B. Rosen, and S. Vijan, The value of medical spending in the United States, 1960–2000. The New England journal of medicine, 2006. 355(9): p. 920–7.

    Article  CAS  PubMed  Google Scholar 

  26. Centers for Disease Control Table 114 No health insurance coverage among persons under age 65, by selected characteristics: United States, selected years 1984–2013, 2014. May 15, 2015. Available from: http://www.cdc.gov/nchs/data/hus/2014/114.pdf.

  27. Committee on Quality of Health Care in America - Institute of Medicine Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy of Sciences. 2001. May 15, 2015. Available from: https://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.

  28. Office of the Legislative Council. The Patient Protection and Affordable Care Act,, Public Law 111–148. 2010. May 16, 2015. Available from: http://housedocs.house.gov/energycommerce/ppacacon.pdf.

  29. The Henry J. Kaiser Family Foundation. State Decisions on Health Insurance Marketplaces and the Medicaid Expansion. 2015 [cited 2015 May 15, 2015]; Available from: http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/.

  30. The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. 2015 [cited 2015 May 15, 2015]; Available from: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

  31. Office of the Assistant Secretary for Planning and Evaluation. ASPE Issue Brief: Health Insurance Marketplace: Summary Enrollment Report For The Initial Annual Open Enrollment Period. Department of Health & Human Services. 2014. May 15, 2015. Available from: http://aspe.hhs.gov/health/reports/2014/marketplaceenrollment/apr2014/ib_2014apr_enrollment.pdf.

  32. US Department of Health and Human Services Health Insurance Coverage and the Affordable Care Act, 2015. May 15, 2015. Available from: http://aspe.hhs.gov/health/reports/2015/uninsured_change/ib_uninsured_change.pdf.

  33. Carman, K., C. Eibner, and S. Paddock, Datawatch: Trends in Health Insurance Enrollment, 2013–15. Health Affairs, 2015. 34(6): p. 1–5.

    Article  Google Scholar 

  34. Congressional Budget Office. Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014, Publication No. 45231. C.o.t.U. States. 2014. May 15, 2015. Available from: https://www.cbo.gov/sites/default/files/45231-ACA_Estimates.pdf.

  35. Grover, A. and L.M. Niecko-Najjum, Physician workforce planning in an era of health care reform. Academic medicine : journal of the Association of American Medical Colleges, 2013. 88(12): p. 1822–6.

    Article  Google Scholar 

  36. Reid-Lombardo, K.M., et al., Workforce shortage for general surgeons: results from the Society for Surgery of the Alimentary Track (SSAT) surgeon shortage survey. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2014. 18(12): p. 2061–73.

    Article  Google Scholar 

  37. Williams, K.A., Sr., et al., Medicare readmission penalties in Detroit. The New England journal of medicine, 2014. 371(11): p. 1077–8.

    Article  PubMed  Google Scholar 

  38. Postel, M., et al., The cost of preventing readmissions: why surgeons should lead the effort. The American surgeon, 2014. 80(10): p. 1003–6.

    PubMed  Google Scholar 

  39. American Medical Association, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), H.R. 2, Pub. Law 114–10, American Medical Association, Editor 2015.

  40. Centers for Medicare & Medicaid Services. Medicare.gov, Hospital Compare - Linking quality to payment. 2015 [cited 2015 July 13, 2015]; Available from: http://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html?AspxAutoDetectCookieSupport=1.

  41. Social Security Administration. Social Security History - 1935 Congressional Debates on Social Security. [cited 2015 May 15, 2015]; Available from: http://www.ssa.gov/history/tally.html.

  42. Social Security Administration. Legislative History - Vote Tallies for Passage of Medicare in 1965. [cited 2015 May 15, 2015]; Available from: http://www.ssa.gov/history/tally.html.

  43. Govtrack.us. H.R. 4872 (111th): Health Care and Education Reconciliation Act of 2010 House Vote. 2010 [cited 2015 May 15, 2015]; Available from: https://www.govtrack.us/congress/votes/111-2010/h167.

  44. Govtrack.us. H.R. 4872 (111th): Health Care and Education Reconciliation Act of 2010 Senate Vote. 2010 [cited 2015 May 15, 2015]; Available from: https://www.govtrack.us/congress/votes/111-2010/s105.

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA

    Marek Rudnicki

  2. Department of Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA

    John H. Armstrong

  3. Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Clancy Clark

  4. Department of Surgery, St. Vincent’s Medical Center, Bridgeport, CT, USA

    Stuart G. Marcus

  5. Advocate Health Care, Downers Grove, IL, USA

    Lee Sacks

  6. Institute for Hepatobiliary and Pancreatic Surgery Beth Israel Deaconess Medical Center and Dana Farber Harvard Cancer Center, Harvard Medical School, Boston, MA, USA

    A. James Moser

  7. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    KMarie Reid-Lombardo

  8. Division of Subspecialty General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55902, USA

    KMarie Reid-Lombardo

Authors
  1. Marek Rudnicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John H. Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clancy Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stuart G. Marcus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lee Sacks
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. James Moser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. KMarie Reid-Lombardo
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Public Policy and Advocacy Committee of the SSAT

Corresponding author

Correspondence to KMarie Reid-Lombardo.

Ethics declarations

Conflicts of Interest

No financial disclosures or conflicts of interest for any of the authors

Additional information

SSAT Public Policy Committee, 2013–2014

KMarie Reid-Lombardo, M.D., M.S, Chair

Edward D. Auyang, MD

David Bentrem, M.D.

Clancy J. Clark, MD.

Ross F. Goldberg, M.D., Vice-Chair

Matthew M, Hutter, MD

Timothy M. Iseri, MD

Daniel B. Jones, M.D.

Tara S. Kent, M.D., M.S.

Kui Hin Liau, MD

David J. Maron, MD

Marek Rudnicki, MD

Shean Satgunam, M.D.

Bruce D. Schirmer, MD

Thomas Schnelldorfer, M.D.

Steven D. Schwaitzberg, MD

Richard Smith, M.D.

Daniel Tseng, MD

Randall S. Zuckerman, MD

Authors Rudnicki and Armstrong are both considered co-first authors as they shared equally in the preparation of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rudnicki, M., Armstrong, J.H., Clark, C. et al. Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons–Pro and Con Arguments. J Gastrointest Surg 20, 351–360 (2016). https://doi.org/10.1007/s11605-015-3032-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-3032-8

Keywords

Search

Navigation