PAs and the Affordable Care Act

Given the dramatic change in the political landscape in America since the last presidential election, I think that it is good to review how the Affordable Care Act (ACA) affects the healthcare system. For the scope of this blog specifically, I will focus on how the ACA affects the physician assistant (PA) profession.

I am acutely aware of how the ACA significantly changed the landscape of healthcare delivery in the U.S., as I was president of the AAPA in 2010 when this landmark legislation was passed. The passage of the ACA was a dramatic turning point in the young history of the PA profession.

The ACA's passage affected the PA profession in the following important ways:

1. More demand for PAs. As millions of the uninsured obtained coverage, many of them for the first time, healthcare delivery systems were swamped. PAs and NPs are a ready solution to the problem of delivering primary care in the US.

2. Recognition as primary-care health providers. This has always been a difficult proposition for the PA profession. Due to our unique relationship with our physician partners, we were seen as "included" in healthcare reform when in fact we were not uniquely identified as one of the three direct patient care providers. This was a huge step forward in legislation, regulation, and reimbursement, the importance of which cannot be overstated.

3. Expansion of PAs. The ACA contains education financing provisions, which supported the expansion of PA training in the U.S. to meet the need for additional primary-care providers.

I have had the privilege of practicing medicine as a PA for nearly 36 years, and I have witnessed dramatic change over those decades. The growth of the profession has been profound since the PA concept was introduced in the 1960s. I have also been active in legislative affairs on the state and national level during most of that time. Early on, the PA profession had to fight tooth and nail just to get a seat at the policy table. The inclusion of PAs was an afterthought in most situations, and we were excluded from the discussion more often than we were included.

Over the first two-thirds of my career, positive progress was made, and more doors were opened. However, the pace of change and improvement in the regulations that govern PA practice was glacial.

Fast forward to 2010 and the passage of the ACA. The significant changes that this legislation made to the U.S. healthcare system changed the equation at every level. Before the ACA, we had to nearly beg to be included at the policy table at the local, state, and national levels. After the ACA and the recognition and maturation of the PA profession, invitations for PA inclusion at the policy tables - at the highest levels - are coming almost faster that we can provide representatives to participate.

The effect was also profound at the state level. State legislatures found themselves having to deal with a severe provider shortage as they struggled to implement the ACA and deliver healthcare to their citizens within the jurisdiction of the state. Before, the legislative agenda of the PA profession was a carefully coordinated and calculated dance between the profession, and the medicine and nursing lobbies of the state. Fast forward to the post ACA world. Now, legislatures are proposing positive changes to the PA practice acts in nearly every state, irrespective of the wishes of the medical and nursing lobbies. This is both a good and a bad thing in that it is almost never desirable to have non-medical people proposing changes to the healthcare systems without the input of the medical and nursing professions.

Just to give you an example, 40 states made 119 legislative improvements and 31 states made regulatory improvements regarding PA practice in 2015 alone. This pace continues to accelerate as the PA profession becomes more crucial to the healthcare delivery system. It will be interesting to see what direction healthcare reform takes in the new administration. One thing is for certain. PAs will be front and center in every solution to solving the human resources problems, and PAs will be at every table into the foreseeable future.