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• W2017402353 abstract "Sir:FigureThis past June, the Supreme Court upheld the Patient Protection and Affordable Care Act as constitutional, and by doing so sparked debate among many parties, including physicians.1 The bill, which broadens health insurance coverage, will certainly impact health care in the United States, including plastic and reconstructive surgery. This article serves to highlight certain policies in the current “Obamacare” bill with which plastic surgeons should be familiar, as the ramifications of the law may significantly affect the field of plastic surgery in the United States. The Patient Protection and Affordable Care Act attempts to increase health care access for Americans by broadening insurance coverage for health care.2 This includes extending coverage for many uninsured children through the expansion of the Children Health's Insurance Plan and Medicaid.3 In addition, with health care use expected to rise secondary to the expansion of insurance coverage, the bill proposes several incentive schemes to recruit physicians to underserved areas and specialties. Furthermore, by establishing the Patient-Center Outcomes Research Institute, it emphasizes comparative cost-effectiveness research, which many academic plastic surgeons already participate in. These programs require funding, and revenues will be derived from various sources ranging from collecting an excise tax on high-cost employer-sponsored health insurance to increasing the Medicare Hospital Insurance tax for those in the high-income category. Initially, it even included a 5 percent tax on cosmetic surgery (section 9017, Title IX). This piece of legislation, however, was felt to discriminate against the middle class and women, and was eventually nullified with the help of strong lobbying by the American Society of Plastic Surgeons.4 Another revenue provision that has not been eliminated, despite American Society of Plastic Surgeons efforts, relates to containing Medicare physician fees through the sustainable growth rate formula. Each year, this highly controversial approach undergoes an adjustment or repeal. The Patient Protection and Affordable Care Act omits addressing the sustainable growth rate formula that can fix the current myopic, short-term “solution” of adjusting the sustainable growth rate annually. Anything short of a full repeal of the sustainable growth rate may jeopardize medical care for the Medicare population, as costs for some physicians to treat these patients may be insurmountable. Lastly, the Patient Protection and Affordable Care Act's implementation of the Independent Payment Advisory Board is concerning. This 15-member board, elected by the president, can submit proposals to Congress that limit Medicare from exceeding target spending levels. These binding recommendations will go into effect unless Congress passes alternative cuts of the same size. Limited oversight over such a board that may not be adequately experienced with the intricacies of patient disease and its surgical management could be problematic. Plastic surgeons must remain politically active and continue to be leaders in organized medicine, and it is imperative that each surgeon understands the policies set forth in the Patient Protection and Affordable Care Act. Although the specialty remains small, the camaraderie and cohesiveness can be used to ensure that our voices are heard in Washington in an effort to deliver the best care to our patients. Anup Patel, M.D., M.B.A. Ajul Shah, M.D. Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn. Devinder Singh, M.D. Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md. Alexander Au, M.D. Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article." @default.
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• W2017402353 date "2013-02-01" @default.
• W2017402353 modified "2023-10-17" @default.
• W2017402353 title "Protecting Plastic Surgery under the Affordable Care Act" @default.
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• W2017402353 doi "https://doi.org/10.1097/prs.0b013e318278d6a5" @default.
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