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The Affordable Care Act in the Funny Pages



The Affordable Care Act is one of the most complex beasts that our leaders in Washington ever birthed. It is also one of the most important and far-reaching pieces of legislation ever.

A recent article in the New York Times on the “ABC’s of the Health Care Law and its future” summed up this new law nicely:

It’s a series of policies and regulations and subsidies and mandates. That’s the reason it’s so complex. It builds on an incoherent medical system with all kinds of public and private insurance and tries to patch the holes. And it affects different groups of Americans in different ways at different times.

We all know what it has been like to work in an “incoherent” health care system. For decades we have lived in a “system” of health care in America where some folks have private insurance, others public assistance, others nothing at all. Different folks for different reasons receive different levels of care.

And on top of this incoherence, the ACA has added policies, regulations, subsidies, and mandates to the fill the gaps.

It is so simple, right?

Of course not, and as most physicians and their practice managers, not to mention consumers at all income levels will attest, there is tremendous uncertainty as to how and in what ways the ACA will bear down on our medical practices and impact our ability to provide care to those in need.

Thankfully, there is a handy guide on this law which has recently come out which I highly recommend to anyone looking for a clear-headed – and fun! – way to understand the ACA and its impacts.

If, like me, you grew up on comic books and still fancy to the funny pages, you will find a new book on the ACA an indispensable source for understanding this new law.

For a simple and yet comprehensive understanding of the ACA – what it is and how it works – the single best source I have found is actually a comic book for grownups. Jonathan Gruber’s Health Care Reformis a graphic novel which uses humor to tell the story of the ACA in an entertaining way.

Jonathan Gruber is not just any another health care analyst. A professor of economics at MIT and Director of the Health Care Program at the National Bureau of Economic Research, Gruber was a central architect of Governor Mitt Romney’s health care overhaul in Massachusetts. Gruber was then a primary advisor to the Obama Administration and Congressional leaders in designing the ACA.

Gruber’s Health Care Reform starts by introducing you to four “typical” Americans. “Anthony” has a good private insurance policy through his employer, “Betty” is retired and on Medicare, “Carlos” goes out into the nongroup individual private insurance market for a policy as his employer doesn’t offer health care insurance, and “Dinah” is uninsured.

Each of these individuals then experiences the same heart attack at the same time. And then through the magic of illustrator Nathan Schreiber’s pen we see how each of these folks are treated in many different ways – due to their health care insurance status -- for the same condition.

Rather than recite sub-paragraph XYZ of section ABC of the Affordable Care Act, Gruber then uses the power of pictures and stories to describe each of the major components of the ACA.

While Gruber is clearly biased in favor of the ACA – he was a major designer of the legislation – the descriptions of the ACA and its likely impacts on businesses and health care providers is one of the few sources of information on the ACA that does not require an advanced understanding of accounting or the US insurance industry to proceed.

Regardless of your political views on whether one believes the ACA was a brilliant piece of progressive legislation or one of the most reckless partisan acts in decades, the reality is that the ACA is here and is being implemented.

And for those bewildered by the crazy quilt system of health insurance currently operating in the US, and for those frozen with anxiety over what the ACA is about to do, Gruber’s book is a great place to start to begin to understand how this law will dramatically change health care in this country.

(Article first appeared in the January 2013 issue of “Mecklenburg Medicine,” a publication of the Mecklenburg County Medical Society – www.meckmed.org)

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