Release Date: June 28, 2012
BUFFALO, N.Y. -- The Supreme Court's decision to uphold much of the Affordable Care Act will not only provide as many as 30 million or more uninsured Americans with healthcare coverage, it may also help foster some important and long overdue changes in the healthcare system, says Tom Rosenthal, MD, chair of the Department of Family Medicine in the University at Buffalo School of Medicine and Biomedical Sciences.
"From a primary care perspective, the most common thing we see in an office setting is that we are now seeing more young people in their 20s than we did because they are covered by their parents' insurance to age 26," he says. That change is adding to health care costs because this is a new population that is now seeking medical care.
However, in the long run, this coverage will prove to be more economical, he says.
"Studies have shown that health care for people without insurance prior to turning 65 and going on Medicare costs close to twice as much in the first few years compared to the costs for those who had been covered by insurance," explains Rosenthal. "Having continuous coverage is an important part of preventive health care. Addressing health risk factors such as early hypertension, high cholesterol and obesity will save health costs later in life."
He also sees as critical the provision in the law that establishes in 2015 the Independent Payment Advisory Board, a national oversight committee that will evaluate the evidence for specific treatments and procedures.
"This committee, modeled after England's National Institute for Health and Clinical Excellence, will look at the clinical evidence and patterns of outcome for, say, treating hypertension or performing back surgery, and will make recommendations based on that evidence and adjust policy and payments accordingly," says Rosenthal.
He adds that it will not only help patients receive the most appropriate care, but physicians will now have a national standard of care to consider when deciding what course of treatment to follow.
"The United States has never had a national standard for care," says Rosenthal, who adds that other industrialized countries have similar organizations that perform this function. "I think this is essential."
In the end, he says, there will need to be more improvements in the health care reimbursement system to accomplish one of health care reform's most basic goals: improving access to the best care at the right place and the right time.
"Certainly, other health care providers can deliver certain aspects of health care but there are points when patients have the right to have access to a physician," he says.
Therefore, increased demand for primary care physicians would be one outcome, says Rosenthal, who notes that currently, many medical students choose specialties over primary care.
"We saw a greater demand for primary care physicians in Massachusetts after they passed their healthcare legislation," says Rosenthal. "Two years after the law passed, a number of new family medicine residencies in the state opened up. When you insure everyone, you wake up the next morning and say, 'We don't have enough primary care providers.'"