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25-11-2012 | Article

The week in review, November 18-24, 2012

medwireNews: This week's stories include: the nuts and bolts of the Affordable Care Act; the global context of US physician experience; another health exchange extension; women who do not gain from the Affordable Care Act; and the future lack of physicians.

ACA details at long last

When it concerns something as complex as implementing the Affordable Care Act (ACA), the devil is in the details. The Obama administration has released a lot of those details by expanding on three key provisions that underlie a lot of the healthcare overhaul.

These provisions include preventing insurance companies from discriminating against pre-existing conditions and other demographic characteristics, establishing a core standard of coverage that states must abide by ‑ albeit in their own way ‑ and having the workplace play a key role in incentivizing the health of employees.

So far, the provisions seem to cut down the middle with regard to what consumer advocates, insurers, and other interested parties hoped for and expected. Over the next month or two they will have a say on the matter, as the proposals are open for comment for a limited time.

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US Physicians crave changes

If the Commonwealth Fund had any say, US health insurance companies would function in a more consistent manner. Based on a survey of primary care physicians in 10 developed countries, published in Health Affairs, an alarming proportion of US doctors deal with patients struggling to pay medical expenses, and time-consuming administrative issues that distract from providing care.

Overall, the study found that a vast majority of US physicians think it is due time for fundamental changes in the health system ‑ and a lot of that has to do with the disparate way the health insurance industry functions.

While the Commonwealth Study is a "frontline view" of how different country's policies impact physician experience, it points out one commonality: their health systems are far from ideal.

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Exchange deadline extended

If ever there was anyone who wanted more details ‑ and time ‑ with regard to the ACA, it was the Republican Governors Association. The committee of 29 Republican governors and two governor-elects wrote a letter to the Obama administration asking for an extension on when they had to decide how their respective states will take part in the health insurance exchanges.

The Department of Health and Human Services Secretary Kathleen Sebelius obliged, and states now have until December 14 to not only decide whether they will go solo with the exchanges versus having government assistance, but to also provide a detailed plan of action as to how that will happen, so that an exchange is up and running by 2014.

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Not everyone is a winner with the ACA

Despite the ACA providing coverage to millions of low-income women who lack health insurance, many other low-income women will still be left out in the cold.

In a study in Preventing Chronic Disease, George Washington University researchers looked into whether this disadvantaged demographic share any traits.

While financial constraints trump other factors in making preventative health services out of reach, the researchers identified low education and poor proficiency in English as additional inhibitors. Altogether, there will be enough underprivileged women to warrant the Centers for Disease Control and Prevention to continue funding its current Cancer Screening Program, which provides access to breast and cervical cancer screening services.

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Supply and demand

The US population is not getting any younger, or shrinking any time soon. While the Census Bureau projects a 36% growth in the segment of the population with the greatest healthcare needs ‑ those over 65 years of age ‑ the Association of American Medical Colleges says the USA will face a dearth of 90,000 primary care physicians, surgeons, and medical specialists by 2020 ‑ a number they predict will swell to 130,000 by 2025.

Meanwhile, the Department of Health and Human Services also predicts that physician supply will only increase by 7% in the next 10 years.

A study in the Annals of Family Medicine predicts that the USA will need to hire 52,000 additional primary care physicians by 2025. While many are tempted to point a finger at the ACA's insurance expansion to explain this surge in demand, the research team contends that the reform law plays only a small part in the scenario.

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By Peter Sergo, medwireNews Reporter