After more than a year of debate on the merits of health care reform, policymakers and physicians are switching gears, assessing the impact of the new law and considering how to improve it.
A strong focus on prevention and wellness is also positive, especially the new 10% tax on tanning salon owners.
"This is certainly a victory for dermatology," Dr. James told Skin & Allergy News.
The hope is that the tax will draw attention to the evidence that tanning promotes skin cancer. Perhaps it also will lead to higher costs for tanning, and thus, to discouraging individuals, especially teenagers, from indoor tanning, he said.
There are some concerns about the health reform law, however. For instance, many areas currently are experiencing a shortage of dermatologists to provide care. More patients in the system could lengthen wait times for appointments even further, Dr. James said.
Both the IPAB and the lack of a permanent fix to the Sustainable Growth Rate formula "are concerning because physicians really need a secure payment system," said Dr. James. He noted that physicians are being asked to make new investments in information technology and hire new employees to ensure that the newly insured can get access to care.
"At the same time, they're undermining our ability to do so by having a very unstable payment system," he said.
Going forward, the AAD "hopes to remain a positive influence in the regulatory framework that's going to come out of this," he said. "How these laws are going to be interpreted and how they're going to be implemented is the next big question."
Indeed, the details of the law are far from clear. The reform package was accomplished in several steps.
President Obama signed most of the health reform provisions into law March 23. Later in the week Congress passed a smaller bill--known as the reconciliation bill--that included corrections to the original package, including additional subsidies for purchasing insurance, and removed some of the more controversial political deals from the law. The President signed that companion legislation March 30.
The new law clears the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years. The law creates health insurance exchanges where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions.
The reconciliation bill removes some of the controversial elements of the Senate-passed bill. For example, it strips out the so-called "Cornhusker kickback,"a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.
The reconciliation bill also includes increased federal subsidies for Americans who can't afford to buy health insurance, and it also lowers financial penalties for individuals who choose not to purchase insurance.
Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians, up to the level of Medicare payments in 2013 and 2014. It also increases funding for community health centers.
The law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals.
Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologicals, and devices must report any payments or transfers of value they make to physicians and hospitals, unless it is under $100 a year, starting in 2013. Manufacturers will also have to report physician ownership stakes. The Health and Human Services department will be required to make this information available to the public.
Finally, starting in 2012, manufacturers will also have to report to HHS all the drug samples they give to physicians, if the drugs are covered by Medicare or Medicaid.
The law also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs paid for while the patient is in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.