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With the passage of the Patient Protection and Affordable Care
Act (PPACA) on March 23, 2010 the nation now faces a complex and
multidimensional set of changes to the health care delivery system.
The passage of the bill was just the beginning of reform, and there
remains much debate regarding the implementation of PPACA. The
current discussions over the provisions of the law illustrate the
importance of advocacy in defining the future of health care.
PPACA already faces the challenges of repeal, budgetary
shortfalls, and Constitutional invalidation. Yet, assuming that
PPACA remains largely intact, it will be the decisions surrounding
its implementation that will truly define the meaning of reform. At
this point in time, the true meaning of PPACA has yet to be
For medical students, now is a prime opportunity to become
involved in advocacy. The decisions made now will directly impact
us in our careers as physicians, and your input merits
consideration. While this requires some time to educate ourselves
on the current reform, and to contact our representatives, it is
time extremely well spent. One example of how reform is right now
taking shape is the current debate over Accountable Care
PPACA calls for the creation of ACOs, and generally defines them
as groups of providers that are tasked with coordinating patient
care and improving efficiency. The bill, perhaps intentionally,
uses vague language and states that ACOs will "promote
accountability for patient populations," and, "redesign[e] care
processes for high quality and efficient service delivery." It is
the regulations put out by the Centers for Medicare and Medicaid
Services (CMS) that will better define the role and composition of
an ACO. Those regulations, published on April 7, 2011 are now
awaiting the feedback of numerous interested parties in the form of
public comment. The regulations are neither simplistic nor
superficial; they span 127 pages of the Federal Register. It will
be the detailed and in-depth comments of highly interested parties
with specialized knowledge that determine the ultimate form of
these regulations. This perfectly illustrates the current
importance of advocacy. The passage of the PPACA is truly only the
beginning of reform.
Advocacy generally is important to the formation of sound public
policy. It can be difficult for a representative to independently
gather all of the specialized knowledge required to make an
informed decision on a particular issue. Rather, representatives
rely on the input of the public, especially those with extensive
knowledge of the issues.
Ultimately, the most important skill in policy making is
accurately predicting the consequences of law. These consequences
can be far reaching and may impact a vast array of people directly
and indirectly. All decisions have benefits and drawbacks, and it
is important for the points of view of those affected to be
A final point is that your time and effort in advocacy is not
wasted; an individual can in fact have a very big impact on future
policies. At a recent briefing in Washington, D.C., Linda S.
Birnbaum Ph.D of the National Institutes of Health said that, "I
can't tell Congress what to do, but I can certainly urge them to
consider all the new science." As PPACA is further defined in the
coming months and years, we will need to rely on the sound reason
and thoughtfulness of constituents to determine the direction of
ACP provides numerous resources for medical students to become
involved in advocacy, including:
ACP Health Policy Intern
Southern Illinois University, Class of 2012
June 2011 Issue of IMpact
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