How Obamacare Will Impact Reproductive Health

Paul R. Brezina; Anish A. Shah; Evan R. Myers; Andy Huang; Alan H. DeCherney


Semin Reprod Med. 2013;31(3):189-197. 

In This Article

Abstract and Introduction


For many years, health care delivery in the United States was accomplished through a complicated and evolving series of publicly and privately available insurance programs. In recent years, the increasing cost of health care as well as the relatively large number of individuals without any health care insurance coverage has prompted repeated attempts to modify or overhaul the current health care delivery paradigm. The largest legislative change to this system occurred on March 23, 2010, when President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA).The PPACA is a multifaceted and sweeping piece of legislation. The law introduces a myriad number of changes into both public and private health insurance. Understanding the law, its implications, and how to navigate through these changes is essential to provide high-quality health care to patients. Although the law or parts of it are still at risk of being modified either through judicial or political action, it is important to recognize the current aspects of the law to understand any future modifications. Providing health care coverage in the United States is sure to be as it has always been: a constantly changing and evolving set of private and public policies that carry with them significant complexities and challenges. Health care providers must constantly strive to maximize access to and quality of medical care in whatever paradigm evolves in the future.


Since at least 1945, when President Harry Truman first called on Congress to develop a plan for national insurance,[1] Americans have struggled with developing ways to balance the often conflicting goals of maximizing access to care while maintaining high quality and affordability. After the introduction of Medicare and Medicaid in 1965, major efforts at the federal level to expand coverage while constraining the rate of spending growth failed under Presidents Nixon and Clinton.[1] The result has been a so-called system that spends far more money than any other developed country while covering fewer of its citizens and producing no better, and in many cases worse, outcomes.[2] On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA),[3] although controversy and uncertainty remain.[4–7] Its objective is to control costs and provide health care coverage for the uninsured, estimated to be >45 million people.[8] To date, only a small portion of the law has taken effect. For example, children up to age 26 are now allowed to stay on their parents' health insurance plan, and the so-called doughnut hole of the Medicare prescription drug plan has now been closed.[9] Most of the law will take effect starting 2014 including its most controversial provision, the mandate that everyone must purchase health insurance.[9]

This topic is important because health care insurance affects each and every one of us directly and indirectly, as providers, as patients, and as taxpayers. The Centers for Medicaid and Medicare Services estimates that health care is projected to be 19.8% of gross domestic product (GDP) by 2020.[10] Although costs have been ballooning for some time, future increases are likely to be even more dramatic given the "silver tsunami" of >80 million Americans expected to retire over the next 20 years.[11] To put into perspective, the U.S. defense budget was 4.7% of GDP in 2010 and currently health care is more than 15% of GDP.[10] In this article, we explain this legislation in simple terms and discuss potential ramifications of this law for the practicing reproductive endocrinologist. However, before explaining the details of the PPACA, it is first necessary to review the sequence of events that led to the creation of the current health care system.