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The Patient Protection And Affordable Health Care Act and Brain Injuries

This week finally saw the end of the drawn out “government shutdown.” As many know, the shutdown itself was seemingly the result of certain members of the U.S. House of Representatives disagreement with the duly passed law known as the Affordable Care Act (Obamacare). Those members of the House sought to delay funding for any government operations–hence in the shutdown–unless the President and other agreed not to fund Obamacare. Naturally, President Obama refused to give into such demands. With the compromise bill passed this week, virtually nothing changes about the law and its roll out will continue.

It is important to understand how the ACA will affect medical care, particularly in the context of brain injuries.

The Law
In what has been deemed the most comprehensive overhaul ever of America’s healthcare system, the Affordable Health Care Act, signed into law by President Obama on March 23, 2010, has forfeited health insurance companies’ ability to deny coverage on the basis of pre-existing conditions. The necessary aftercare and rehabilitation of severe brain injuries is, of course, one such area of medical care that affords examination in light of the fact that such injuries were previously subject to lifetime limits in terms of coverage. Additionally, the efficacy and practicability of extending lifetime coverage to patients suffering from brain injury, most especially severe or traumatic brain injury, merits examination in light of the new health care initiatives.

The New Health Care Act and Its Implications for Treatment
The implementation of the Affordable HealthCare Act remains to be seen. In the case of brain injuries, the question of providing lifetime care under the new health care mandate will inevitably be a source of controversy.

One of the hallmarks of this impending federal health care system is in its directive to provide efficiency, but the nature and treatment of brain injury does not fall neatly into a capsulized definition of such. Brain injury does not lend itself to rapid diagnosis or definitive treatment. It is a slow, uncertain process that often does not adhere to time limits or measurable, objective improvement. One of the measures under the new act requires physicians to demonstrate “overt (behavioral) recovery”, or appropriate measures of improvement: something that is not conclusive in brain injury patients. The brain may be recovering on the inside, but not demonstratively so on the outside. The increased accessibility for pre-existing conditions as allowed for by the new health care system for brain injury cases is predicated on the understanding of these types of injuries and how it falls within the new health care act’s parameters of what it terms efficiency.

Future Challenges
The appropriate length of care, as defined by the Affordable Health Care Act will be subject to challenge and a great many revisions in language and implementation as it relates to brain injury. If left unanswered, brain injury patients could be at risk of losing their eligibility for lifetime coverage limits unless the issues of ethical versus performance (efficiency) questions are addressed.

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