Pain Management Center of Paducah, Paducah, KY, USA.
Pain Physician. 2012 Sep-Oct;15(5):E629-40.
The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. While proponents argue that ObamaCare will provide insurance for almost everyone, with an improvement in the quality of and reduction in the cost of health care,, opponents criticize it as being a massive bureaucracy laden with penalties and taxes, that will ultimately eliminate personal medicine and individual practices. Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional pain management is unclear. The damage sustained to interventional pain management and the majority of medicine practices is irreparable. ObamaCare may provide insurance for all, but with cuts in Medicare to fund Obamacare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training.
《患者保护与平价医疗法案》(ACA),俗称奥巴马医改,是美国总统巴拉克·奥巴马于 2010 年 3 月 23 日签署成为法律的美国联邦法规。ACA 极大地改变了美国医疗实践的格局,并继续影响所有领域,特别是不断发展的专业领域,如介入性疼痛管理。奥巴马医改在重大政治后果中签署成为法律,经受住了最高法院的挑战,虽然伤痕累累,但仍然存活下来。虽然支持者认为奥巴马医改将为几乎所有人提供保险,并改善医疗保健质量和降低成本,但反对者批评它是一个充斥着罚款和税收的庞大官僚机构,最终将消除个人医疗和个体实践。根据 2010 年通过 ACA 后的 2 年来看,介入性疼痛管理的预后尚不清楚。介入性疼痛管理和大多数医疗实践所受到的损害是无法挽回的。奥巴马医改可能为所有人提供保险,但由于削减医疗保险为奥巴马医改提供资金,医疗补助计划的有限扩大,交易所资金不足,雇主健康保险覆盖范围下降和残疾索赔飙升,实际上将没有任何保险。奥巴马医改由众多组织和机构组成,负责通过扩大监管来控制医疗实践。除了削减报销和减少介入性疼痛管理的机会外,行政官员还决心通过放宽实践法规的范围并提出减少医学教育和培训的提案,来增加中级从业者的角色并减少个体医生的角色。