Changing Landscape of Health Care

Unless you have been living on another planet somewhere, the changes in health care taking place in this country have become hard to ignore. With all the debate over recent health care reform, it is sometimes difficult to know who is right, and who is wrong. How can there be such a wide gap in opinion on “Obama care”? How are these reforms changing the landscape in health care, and how are we to survive these changes? To begin, let’s look at how all these changes began.

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The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act was passed in the senate on December 24, 2009. It passed in the house on March 21, 2010, and was signed into law by President Obama on March 23rd, 2010. It was then upheld in the Supreme Court on June 28, 2012, and the landscape of health care has been changing ever since. Few would argue that health care reform was needed, as the cost of health care had been out of control for some time in this country. However, many in the health industry feel that although the intent may have been honorable, the repercussions of reform-compliance is wreaking havoc in the health care industry and may lead to even further problems.

The Trickledown Effect

Most of the issues surrounding the changing landscape of health care are a direct result of health care reform. Changes in legislation have produced a trickledown effect, beginning with the small rural hospitals. For example, one such opinion is expressed by Dr. Scott Litten in a blog on the website Physicians Practice, where he states:

While the intent of the ACA was good, the aftershocks [of the passage of The Affordable Care Act] are changing the very way we practice medicine. Small hospitals in rural areas will be the first ones to enact changes. Reimbursements are not increasing and the new penalties that hospitals across the nation face for readmissions within 30 days, the decreasing numbers of actual admissions, and the increasing numbers of outpatient observation admissions are forcing all facilities to lay off personnel and decrease services provided. Coupling this with the fact that fewer patients are coming to doctor’s offices for services produces a very steep decline in revenue. (Litten, 2013).

According to Dr. Litten, this decline in revenue is just the tip of the iceberg. Businesses are facing a similar problem. Insurance premiums are rising, forcing employers to pass this cost on to the employee, making it more expensive each time they receive health services. This in turn discourages trips to the doctor’s office, and the cycle is repeated. Contributing to this decline, Medicaid also has been slow to increases coverage, forcing many practices to no longer accept Medicaid patients. Dr. Litten believes the changes practices are facing have produced a perfect storm for our healthcare industry. And to top it all off, the sluggish economy is causing everyone to cut back on regular spending, which has a trickledown effect on medical practices and hospitals alike. He further sees no change in these effects in the near future, and believes physicians will continue to struggle with how to provide quality health care with less resources.

The Wide Gap in Opinion

Prior to the passage of the Affordable Care Act, most Americans would have agreed health care reform was needed in this country. However, the wide gap in opinion on whether “Obama care” is a good or bad thing seems to center on how this legislation may lead to an even greater problem: government controlled health care. One anonymous physician blogger put it this way: “The Affordable Care Act was nothing more than a huge power grab by the government, the Executive branch in particular. All of the resulting chaos is planned, which will ultimately force out private insurance and thereby establish a single payer system (government) with physicians becoming part of the public service union. When that comes to pass, I’ll retire or maybe set up a “boutique” practice working 2-3 hours/day; 2-3 days/week for the patients who can afford it. My selfish concern is: who will be there to take care of me when I need it? Fortunately, I will be in a position to pay for a concierge doctor. Welcome to British style medicine. (Anonymous, 2013).

Even advocates of “Obama care” express concern that nothing in it addressed malpractice costs and tort reform, economic price feedback loops, or increased responsibility on behalf of the consumer. Another blogger states “It, [The Affordable Care Act] means more people are eligible for subsidized coverage which will add to the long term deficit issues and healthcare costs unless other changes are made.” (Litten, 2013). These issues, along with others that may arise before full implementation of The Affordable Care Act are realized, will need to be addressed if we are indeed to be successful in attaining affordable health care for all Americans.

Adapting to Change

How are we as an industry and a people to survive these changes? Mark Twain once said “It’s not progress that I mind, it’s the change I don’t like,” and the same can be said of the health care industry. People in general are opposed to change, especially when they do not have a good understanding of the issues. But “Obama care” is here to stay, and understanding the intent, specific benefits, and potential for positive reform is the first step in adapting to these changes. We have the ability to research and investigate the many options available to us as both consumers and providers of health care. Knowing what health care reform means on a personal level as well as a business level will not only help us understand and adapt to health care reform, but we may also find that there are many way this reform may indeed work to our benefit in the long run.


Litten, S. J. (2013, May 24). Health Care Reform is Changing the Landscape in Medicine. Retrieved from Physician Practice Web site:

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