One month into the ACA, trouble looms

When will the dust settle around implementation of the Affordable Care Act? It’s hard to say. The well-publicized technical issues will probably (hopefully?) be overcome. One wonders if the real issue is the sheer complexity of healthcare financing. Determining who qualifies for which of a myriad of different existing government-run programs (Medicare, Medicaid, Tricare, etc) and a variety of other insurer’s plans could of course be avoided by having a single-payer system. Discarding that musing momentarily, I feel it is imperative to avoid a “rush to judgment” about the failure of Obamacare. Of course, recent news about insurance companies canceling existing individual plans, contrary to President Obama’s consistent message that people could keep their current plan, is adding fuel to the fire upon which opponents would toss the ACA. In point of fact, many of those people who are being instructed to seek insurance through the exchanges instead are finding more affordable plans – but the news focuses on those who were hard done by, having to substitute their existing plan for a less affordable one and understandably, these people are upset. What is the breakdown of those who suffered versus those benefiting – we’re not yet sure. Regardless, it appears the President was perhaps misinformed or unprepared for the response of the insurance companies (I hate to think disingenuous). Nevertheless, this too shall pass.

However, one of the things that will soon be thrown into sharp relief is the shortage of primary care physicians. Congress’ failure to fund several provisions of the ACA, such as the National Workforce Commission and the Primary Care Extension Program, makes the threat of insufficient access even greater. It has been difficult to push for these things at the national level given the current fiscal environment, although truly the amounts involved are relatively small; there is even bipartisan agreement in principle, however simply because these are provisions of the ACA, political lightning rod that it is, there is no progress to be had. Shame.

Locally, this coming shortage provides more ammunition for the Connecticut APRN Society to push for an expansion in scope of practice. Legislators will be tempted to address the issue by granting this expansion. How do we counter? Are the primary care physicians of Connecticut ready to handle the potential increase burden of patients? Will more be demanded of already overburdened safety net practices? Let’s hear your voice in this debate.

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