The Patient Protection and Affordable Care Act, or ACA, represents the largest overhaul of the U.S. healthcare system ever. Since the administration of Franklin Delano Roosevelt, presidents have attempted to influence or reform the health care and insurance systems. On March 23, 2010, President Obama succeeded where previous presidents had failed.^[1] With the enactment of the ACA, 32 million of the currently 46.3 million uninsured Americans will become insured, leaving 23 million nonelderly adults uninsured by 2021.^[2] The 15.4% of the population which is uninsured results in 45,000 unnecessary deaths per year.^[3] The ACA aims to decrease this number while increasing healthcare quality and decrease costs. This is accomplished by increasing insurance through exchanges and Medicaid, increasing the number of healthcare professionals, not only doctors, but also Physician’s Assistants, Nurse Practitioners, and LPNs, and shifting the focus from quantity (of tests, patients, surgeries, etc.) to quality and patient outcomes.
     But how will this massive overhaul affect you, a pre-medical student studying at UVA? The effects of the law are incredibly widespread, affecting almost everyone in the healthcare field, from insurance executives to nurses, from physician’s assistants to hospice workers. The ACA has already begun to influence aspiring doctors.

As Undergraduates
     One of the most widely-known reform introduced by the ACA is the ability of young adults to remain on their parents insurance until age 26.^[4] Specifically affecting 25,800 young adults in Virginia alone, this provision of the law will benefit anyone unable to find work or unwilling to purchase an individual plan in the new exchanges (starting in 2014).^[5]
     In an attempt to increase the number of health care professionals, the ACA allocates $40 billion in additional funds for Pell grants for undergraduate and graduate students.^[6]

As Medical Students
     The portions of the ACA which affect medical students are aimed at increasing the number of primary care physicians and nurse practitioners, especially in medically underserved areas. Two billion dollars have been allocated for scholarships and loans for primary care professionals willing to work in medically underserved areas through the National Health Service Corps. This will impact the 9% of Virginians living in these areas. Through public sector loan forgiveness, healthcare professionals working for the government or non-profit organizations are eligible to have their loans forgiven after ten years. Another provision of the law caps federal loan repayment at 10% of discretionary income and provides that these loans will be forgiven after 20 years. Another goal of the ACA, to increase doctors choosing primary care is addressed by exempting the value of student loans from taxes.

As Residents
     To address growing shortages of basic medical care, the ACA allocates $168 million for 500 new primary care physicians. Currently unused Medicare-funded resident training slots will be reallocated to primary care residencies in underserved areas of the country. The teaching hospitals which receive these residencies must maintain their number and keep 75% of them as primary care or general surgery.^[7]

As Physicians
     The ACA introduces 32 million newly-insured Americans to an already-burdened healthcare system. While the law attempts to alleviate this expansion with $250 million for 16,000 new primary care professionals,^[7] there is still fear of a shortage of physicians.^[8] Conversely, the law lessens the financial burden of 46.3 million uninsured Americans on physicians, hospitals, and the healthcare system in general The reform also mandates transition to electronic medical records, a controversial new system, praised by some and reviled by others.^[7] A large provision of the ACA is the movement towards physician payment based on quality of care and outcomes. Starting in 2015, a relative value-based modifier will be established to reimburse physicians based on high-quality care and good results.^[9] The Department of Health and Human Services is establishing a website called “Physician Compare” to facilitate physician selection based on individual outcomes. Also starting in 2015, participation in this website is mandatory, with a 1.5% reduction in Medicare payments for noncompliance.^[7] The ACA aims at promoting the creation of Accountable Care Organizations. These would be composed of groups of doctors and healthcare administrators with the goal of coordinating Medicare patient care. With more than half of Medicare beneficiaries having five or more chronic conditions and one in seven admitted to a hospital experiencing a harmful medical mistake during care, improvements to care of Medicare patients is essential.^[10] Furthermore the law changes Medicare policy to bundle payments for treatment providers, such as surgical teams. These reforms are aimed at saving Medicare money, savings which would be shared between the ACOs and the federal government through the Medicare Shared Saving Program.^[7] As a result, healthcare experts are advising individual physicians and small-group practices to align themselves with larger healthcare enterprises in order to effectively take advantage of these new arrangements. With Medicare and Medicaid accounting for $602 billion in payments (44% of all medical expenditures in the US), changes to payment procedure will have a large impact on the healthcare industry.^[11]
     For primary care physicians (PCPs), the ACA increases Medicaid payments,^[7] while introducing 16 million participants to the program.^[1] It also places an emphasis on preventative services, for example wellness physicals for all new entrants to Medicare. This may force a change in the focus or scope of services offered by PCPs in the future.^[7] The ACA also compels referring physicians to provide a comprehensive list of specialty providers when referring patients. This regulation, along with the “Physician Compare” website and Physician Quality Reporting Initiative will provide more transparency in physician choice, while holding doctors more accountable for patient outcomes.
     The ACA’s reforms are so widespread that a complete list of its effects would be a grueling undertaking. This is an introductory list of the major components of the law affecting doctors (or would-be doctors). The overall effect on pre-med students is increase access to loans and promotion of work in medically-underserved areas and in primary care. With the increased cost of medical school, increased residency slots and loan forgiveness for primary care professionals should provide incentives for this field.

Works Cited

1."Health Care Reform." The New York Times. The New York Times, 30 June 2011. Web. 15 July 2011. http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtop... insurance_and_managed_care/health_care_reform/index.html.
2."Health Care." Congressional Budget Office. Congressional Budget Office, 30 Mar. 2011. Web. 17 July 2011. http://www.cbo.gov/publications/collections/health.cfm.
3.Cecere, David. "New Study Finds 45,000 Deaths Annually Linked to Lack of Health Coverage | Harvard Gazette." Harvard Public Affairs & Communications. Cambridge Health Allliance, 17 Sept. 2009. Web. 14 July 2011. http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deat....
4."Timeline of the Affordable Care Act." HealthCare.gov. U.S. Department of Health & Human Services. Web. 14 July 2011. http://www.healthcare.gov/law/timeline/index.html.
5."The Affordable Care Act: Immediate Benefits for Virginia." Health Reform. U.S. Department of Health & Human Services. Web. 12 July 2011. http://www.healthreform.gov/reports/statehealthreform/virginia.html.
6."Creating Jobs and Increasing the Number of Primary Care Providers." HealthCare.gov. U.S. Department of Health & Human Services, 16 June 2010. Web. 13 July 2011. http://www.healthcare.gov/news/factsheets/creating_jobs_and_increasing_p....
7."Health Care Providers and the Affordable Care Act." HealthCare.gov. U.S. Department of Health & Human Services. Web. 10 July 2011. http://www.healthcare.gov/law/infocus/providers/index. html.
8."Doctor Shortage Could Hurt Healthcare Reform." Chronicle of Nursing. Nursing Journals. American Society of Registered Nurses, 2009. Web. 04 Aug. 2011. http://www.asrn.org/journal-chronicle-nursing/617-doctor-shortage-could-....
9.Sharamitaro, Anne. "Healthcare Reform: Impact on Physicians." Health Capital Topics. Health Capital Consultants, Feb. 2011. Web. 7 July 2011.
10."Accountable Care Organizations: Improving Care Coordination for People with Medicare." HealthCare.gov. U.S. Department of Health & Human Services, 31 Mar. 2011. Web. 11 July 2011. http://www.healthcare.gov/news/factsheets/accountablecare03312011a.html.
11."Medicaid and Medicare." Kaiser Family Foundation. Henry J Kaiser Family Foundation. Web. 12 July 2011.