The Patient Protection and Affordable Care Act is an American law passed in March of 2010. Its primary goal is to achieve universal health insurance coverage by facilitating cooperation among employers, citizens, and the government. Its other objectives are to make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending. To this end, the Act puts specific emphasis on primary and preventative care. The Act requires that all US citizens and legal residents purchase health insurance to increase the pool of healthy individuals enrolled. This "individual mandate" spreads around the associated risk while subsidizing coverage for the economically disadvantaged. It potentially includes an expansion of Medicaid, at the discretion of the state governments. Additionally, the Act promotes the creation of state health insurance "Exchanges" that allow employers and individuals to select health insurance options that are eligible for federal subsidies in accordance with state and federal regulations. Subsidized plans that meet these requirements are called "qualified health benefit plans." To achieve universal coverage, the Act also bars insurance companies from refusing coverage to those under 19 years of age with pre-existing conditions, prohibits cost ceilings on essential health benefits, and allows children less than 26 years of age to stay on their parents' health insurance plans. In an effort to more thoroughly integrate employers into the program and promote preventative care, the Act incentivizes the creation of "wellness programs" in the workplace by offering discounts, rebates, and waivers towards the cost of insurance.[1][2]

Relevant concerns about the Patient Protection and Affordable Care Act include is constitutionality, affordability, and efficaciousness. Critics of the Act insist that its "individual mandate" requiring citizens and legal residents to buy health insurance forces them to purchase a product they do not want, a power that does not fall under the federal government's ability to regulate interstate commerce under the Commerce Clause (Article I, Section 8, Clause 3) of the U.S. Constitution. Another concern is that since the Act is a federal law, ensuring that the states are enforcing it would require the federal government to override state law enforcement in violation of the U.S. Constitution's 10th Amendment protection of states' rights. This, in turn, would require the states to voluntarily enforce the Act's provisions, leading proponents of the Act to fear that it will be improperly or incompletely enforced. Regulation that could potentially be ignored by state governments include prohibitions on discrimination against people with pre-existing conditions, excessive waiting periods, and requirements for internal and external impartial appeal procedures implemented when coverage is denied.[1] Other concerns include the possibility that the Act might disrupt existing healthcare coverage, force employers to curtail or abandon coverage for their employees, overwhelm healthcare providers with new patients, reduce the quality of provided services, and increase health care costs, though proponents of the law say that these concerns are exaggerated.[3][4]

The Patient Protection and Affordable Care Act has significant clinical implications for various branches of medicine. For instance, critics of the Act insist that it has been shown to increase costs and reduce the quality of end of life care received by cancer patients, thereby adversely affecting patients receiving hospice care.[5] However, its proponents insist that the Act's Medicaid expansion component has increased access to care for diabetics, patients suffering from trauma, and patients requiring emergency surgery.[6][7][8] Also, data suggested reductions in inpatient hospitalizations due to Medicaid expansions covering ambulatory care under the Affordable Care Act, thereby producing cost savings for the US health care system.[9][8] Another component of the Affordable Care Act, Dependent Care Provision, has increased insurance coverage in young adults with cancer.[10]

The Patient Protection and Affordable Care Act has had a particularly unique impact on the conduct of physicians as well as auxiliary health care providers like nurses. Proponents of the Act say its linking Medicare payments to readmission rates disincentivized readmissions and thereby encouraged physicians to develop leadership skills to increase the quality of care.[11] Proponents of the Act also believe that it helped public health nurses to integrate primary care with broader public health, prioritize preventative health care, and coordinate care more efficiently with other providers.[12] The ACA also accounts for new payment methodologies, based on outcomes, replacing traditional "fee for service" payments. Therefore mandating hospitals to implement new programs by creating "care coordinators"- paid nurses who make sure that patients are getting appropriate follow-up care, thereby optimizing hospital reimbursement. These new implementations also require complex data reporting, need for sophisticated information technologies; thus, institutions have to be prepared to adapt to the new healthcare trends. On the other hand, health care providers have to work in conjunction with other hospital interprofessional teams and subspecialties to get through this cultural transformation to better acclimate to the new methodologies. Due to changes in reimbursements, increasing regulations, need for expensive electronic medical record systems (EMRs), individual physician practices are having a tougher time and eventually either bought or merged into larger groups and hospital-owned practices.