Two days after PPACA became law, Rep. Steve King (R-Iowa) introduced a
bill, H.R. 4972, to repeal the Patient Protection and Affordable care
Act, which was then sent to a number of committees for comment.
Headlines lately have suggested that the law will be repealed, but in
reality, this effort is very unlikely to ever make it through the Senate
and pretty much amounts to political posturing. The opposition is
attacking from a number of angles. A less lethal, but crippling blow
would be to defund areas that involve healthcare reform, thus making the
PPACA law ineffective. Fred Upton, the new chairman of the Energy and
Commerce Committee, stated that the House will try to dismantle the law
"piece by piece" and "we'll see if this thing will crumble."
Lawyers are challenging the constitutionality of the law in federal
courthouses as Republican governors do the same thing at the state level
- all the while taking millions in federal funds associated with
healthcare reform for their state. Even states suing to nullify the law
requiring most Americans to carry health insurance are proceeding with
at least some of the building blocks. The challenge to PPACA
constitutionality will be decided by the Supreme Court. However, the
Court could simply choose to nullify parts of the law -- e.g., the
disputed "individual mandate" to buy health insurance -- without
necessarily overturning the entire law.
ow does the average American feel about healthcare reform? Polls show
that one in eight people believe they have been personally helped
already, well before the meat of the legislation will kick in by 2014.
1
A recent Kaiser Family Foundation poll noted that one in five Americans
said they were negatively affected by the law, citing cost
specifically. Attitudes about PPACA have remained steady in the past
year. Roughly half the American public polled - 53 percent- remain
confused about the law while 47 percent responded that they lack
sufficient information to clearly understand how it impacts them.
A Gallop poll released in March illustrated similar results according
to whether "... the restructure of the American healthcare system is a
good or bad thing;" 46 percent responded "good" while 44 percent
responded "bad." Opinions remain sharply polarized along partisan lines
where more than two thirds of Democrats support the law and most
Republicans oppose it.2
One of the major issues with public opinion is that the majority of
the legislation will not go into effect until 2014, leaving Americans to
speculate and hear misleading sound bites cleverly produced by the
opposition to create fear in the general public, for example that the
law means a "government takeover of healthcare," a gross overstatement.
A number of those polled believed the law has already been repealed.
The truth is that no one can really predict the outcome of healthcare
reform as it is currently written. If it's thoughtfully developed and
well orchestrated, it can be one of the best things that could happen to
our country this millennium. If it's poorly prepared for and
mismanaged, it could be a complete debacle.
A Recap of The Past Year
There are 159 new agencies and programs born out of PPACA.
Noteworthy steps forward include putting together the governing board of
the Patient Centered Outcomes Research Institute (PCORI). Comparative
Effectiveness Research (CER) is a huge step forward in the research
community compared to the "gold standard" of Randomized Controlled
Trials (RCTs), which are structured for pharmacological intervention.
The HHS website defines CER as "the conduct and synthesis of systematic
research comparing different interventions and strategies to prevent,
diagnose, treat and monitor health conditions. The purpose of this
research is to inform patients, providers, and decision-makers,
responding to their expressed needs about which interventions are most
effective for which patients under specific circumstances. To provide
this information, comparative effectiveness research must assess a
comprehensive array of health-related outcomes for diverse patient
populations. Defined interventions compared may include medications,
procedures, medical and assistive devices and technologies, behavioral
change strategies, and delivery system interventions. This research
necessitates the development, expansion, and use of a variety of data
sources and methods to assess comparative effectiveness." The other
pertinent advisory committee relating to AOM would be the National
Healthcare Workforce Commission. That committee will evaluate the
future needs of the nation and what multidisciplinary team of health
care professionals is required to meet those needs.
According to the Office of Inspector General (OIG) report in
February detailing top management and performance challenges of the
Department of Health and Human Services for 2011, healthcare reform was
one of the top four. The main issues pertaining to PPACA include:
"...tight implementation timeframes; compliance with program rules;
accuracy of claims data and payments; effective oversight of grants,
contracts, and other obligations; quality of care; changes to Part D and
other Medicare and Medicaid programs; and fraud schemes that put HHS
and its beneficiaries at risk."
One of the highlights implemented this year is a 50 percent price cut
on brand name prescription drugs for Medicare patients who fall into
the coverage gap called the "donut hole." Republicans say much of these
gains will be temporary. Sen. Orrin Hatch, (R-Utah) stated: "For
families, any marginal benefits from this law are far outweighed by the
heavy-handed intervention in their health care by Washington
bureaucrats."
The proper implementation of the law will open the door to more
reform, including the broad-spectrum use of complementary and
alternative medicine. The current paradigm in the United States is one
of "sick care" rather than 'health care," and we need to find a way to
introduce more of a wellness focus to the system. The term wellness is
frequently used, but rarely applied. Prevention and early detection are
two very different approaches to improved health of our nation, and
many lawmakers have referred to mammograms and colonoscopies as
"prevention" which is misleading. Speaking of terminology, the moniker
"integrated health practitioner" has been batted around for years with
few legislators able to define it. Due to a task force assembled by the
Integrated Healthcare Policy Consortium (IHPC), the definition was
refined and issued in a press release on January 13, 2011 entitled
"Policy Statement on the National Healthcare Workforce in an Era of
Integration." The statement was as follows:
Seeking a balance between strongly held values of patient access to
health care therapies and professionals of their choice and proper
recourse if inappropriate or unethical care should occur, IHPC supports
inclusion in the National Healthcare Workforce of:
1) All licensed conventional, complementary and alternative healthcare providers.
2) All state certified healthcare providers.
3) All nationally certified healthcare providers when the
certification agency is accredited by the National Commission for
Certifying Agencies (NCCA) of the Institute for Credentialing Excellence
(ICE).
For healthcare professions that do not yet have state
licensure/certification/registration or national certification, IHPC
strongly encourages them to pursue state licensure/
certification/registration and/or national certification.
There are several areas in PPACA that refer to integrative
healthcare. Given the new law, consumer popularity, the trend of major
academic centers to be inclusive of integrative clinical centers and
education in the medical school curriculum, and the potential of cost
effectiveness, it is my contention that integrative healthcare will be
an important and sustaining future trend in the redesign of healthcare
delivery in the United States," said the chair of IHPC, Leonard
Wisneski, MD, Author of "The Scientific Basis of Integrative Medicine."
So how does this statement affect AOM professionals? We obviously
fall under the broad category of licensed healthcare providers (in 44
states and growing). The number of times "acupuncture," "chinese
medicine," or "Oriental medicine" is cited in the entirety of the health
reform law is zero. However, it provides a foot in the door - a place
at the table for further conversation. AOM is integrated in a number of
European countries' healthcare systems - it's about time America
catches up.
However, the future for our profession is very bright.
A recent national health interview survey by the National Center for
Complimentary and Alternative Medicine (NCCAM) at NIH show that the
number of visits to acupuncturists rose by 32 percent in five years and
that U.S. adults spent $33.9 billion out of pocket, a third of which
were CAM practitioner costs. Additionally, there is rising concern
about the number of physicians graduating, especially general
practitioners/family practice MDs, in the future. In the past century,
general practitioners grew with the local population. Now with more
specialization, fewer MDs are choosing family medicine and projections
suggest there will be a shortage of GPs from 2010 forward3.
AOM practitioners can assist in filling the gap. There are 65
accredited OM schools in America with over 8,000 students in the
pipeline to serve the future public. Keep in mind that you will never
be required to participate in insurance plans; just like today, it's
purely your choice to remain a cash-based practitioner, or become a
preferred provider.
References:
- Alonso-Zaldivar, R., "At first birthday, health overhaul faces uncertain future," The Salt Lake Tribune, Mar 21, 2011
- Blumenthal, M., "Health Reform Law: Same Opinions One Year Later," Huffington Post, Mar 25, 2011
- Colwill, J.M., Cultice, J.M., "The Future Supply of Family
Physicians: Implications for Rural America," Health Affairs, 22, 1
(2003): 190-198
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