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On July 1st (next Thursday), Virginia's Attorney General Ken Cuccinelli goes to court to defend his lawsuit alleging that the recently enacted Affordable Care Act (ACA) is unconstitutional.  As Cuccinelli tries to ensure that millions of Americans remain without true access to medical care and health insurance, activists will gather outside of the federal courthouse to ensure that the law's newly established patient protections and insurance regulations will be preserved.

I have been asked by the Virginia Organizing Project to say a few words regarding the benefit that I see this law will bring to patients in Virginia.  I thought I would jot some notes down here, and start organizing my thoughts:

--First, as a physician who cares for a large proportion of uninsured patients, the reforms enacted by the ACA will ensure that patients will be able to secure health insurance and access health care.  I have had to work with far too many patients whose medical problems have been uncontrolled--sometimes to the extent of threatening life or limb--because they have not been able to get routine and regular medical care.  The ACA will start providing access to insurance to uninsured people as early as this year, with access expanding over the next five years as the health insurance exchange is developed.  Also, small businesses start receiving tax credits this year in order to defray the cost of providing employees health insurance.  Finally, young adults will be able to stay on parents' policies until they turn 26, thereby ensuring that these young people can extend their education and/or begin their careers without having to worry about securing affordable health insurance at the same time.

--The previous administration enacted a Medicare Part D drug benefit program for seniors, but in order to hide the true cost (which was inflated by the law's requirement that Medicare could NOT negotiate for lower prices from drug manufacturers) the benefit included a "donut"hole.  This gap in coverage made seniors 100% responsible for their medication costs after reaching a certain level of expenses during the year, and the gap continued until patients reached a level of out-of-pocket costs deemed to require further assistance.  This gap complicates medical care, as seniors' drug costs shoot up during the donut hole and many have significant difficulties managing this sudden increase.  The ACA will start to provide some help in the form of $250 rebate checks this year, but the donut whole will start to close and continue closing until it is fully done away with.

--Health insurance reform will ensure that insurers actually have to provide health care to patients who carry their policies.  The policy of recissions, where insurers could drop your policy for any reason (even an honest mistake) despite the fact that you had paid up your policy will be eliminated.  Pre-existing conditions will be ended.  Insurers will be required to keep a certain medical-loss ratio, meaning that they will have to spend 80-85% of policy premiums (YOUR payments to the company) on providing health care--not salaries, bonuses, etc.  Preventive service coverage will be expanded, allowing patients to seek screening and health maintenance services and hopefully stop problems before they fully start.

--The ACA provides additional funding to public health, coverage for rural health care services and tax relief for health professionals working in underserved areas.  These services play critical roles in some of our nation's most isolated and/or economically marginalized communities and we desperately need to strengthen their ability to continue in these key roles.

These things are all scheduled to begin in 2010 and early 2011.  Over the next 7 years the law will see its full effects and I think that the nation, and patients as individuals, will be better off.

And I hope Cuccinelli's windmill-jousting ends next week.