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
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
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
"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
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.'"