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For the first time, millions of previously uninsured Americans now have access to health insurance, thanks to the Affordable Care Act. Now there’s a one-stop resource for health care professionals needing help to navigate the 900-page law, thanks to Law School Professor Mary Ann Chirba and Adjunct Lecturer Alice Noble, authors of Health Reform: Law and Practice.
Rather than focus on the various well-documented political and social controversies surrounding the ACA, Chirba and Noble offer a more practical view of the law.
“The book deals with implementation and compliance,” says Chirba. “It’s not headed for the New York Times bestseller list. It is two volumes and 2,000 pages, intended for those charged with complying with the statute: law firms, attorneys, compliance officers, hospitals, physician practices, insurance companies, state regulators, and so on. It’s very technical.”
In fact, Noble and Chirba, both specialists in health care law, didn’t come up with the idea for Health Reform themselves. They were invited to help write the book by a major legal publisher.
“As an academic, this law was something I had been eagerly awaiting for many years,” says Noble. “I’m very interested in the topic, so when an opportunity comes along as this one did — to take the statutes and actually read them, analyze them, understand them in a way that most people won’t have the chance to – I jumped at it. This was really a once-in-a-lifetime opportunity.”
Putting the book together took three years of research, not only of what made up the Affordable Care Act, but also how the law affected newly updated regulations. The level of detail involved was particularly challenging, according to Noble and Chirba.
“It is very tedious work,” says Noble. “Legal work can be very dry, and you have to be really patient and persistent, and not really mind that’s it not the most exciting reading. But it’s very interesting if you’re trained to appreciate the law.”
“It would take so long to read the law to really figure out how it was working – that was just for the statute itself,” says Chirba. “The same was true for the regulations. Then we had to integrate the two, even though the regulations were constantly coming out.”
While the law has been the object of endless debate, rhetoric, a government shutdown, and a Supreme Court decision, Noble and Chirba say the ACA is about more than the much-maligned healthcare.gov website, which served as both a symbol and target for critics but has been significantly improved.
“It is a much broader law than people realize,” says Noble. “There are three areas – cost, quality and access — that are really key elements to any rational health care system. The Affordable Care Act is designed to improve the quality of care, decrease cost or at least decrease the rate of increase of the cost of health care, as well as improve access.”
Adds Chirba: “It’s not a federal takeover by any means, and is really based on improving and preserving the market. What I liked about the ACA is that many parts of the statute take this philosophy: ‘We don’t know how to do this really well, and we don’t know how to do this really efficiently. So what we will do is set up goals and offer incentives and leave it to you to figure out how to do this, how to do it well in terms of improving quality, improving access to coverage and making it more cost-efficient.’
“The law puts the ball in the doctors’ court, in the hospital’s court, and they’ll set objectives.”
Noble says the implementation phase of the ACA will bear watching: “There are going to be a number of unintended consequences, some good, some not so good. I think we’re going to see a move to revisit certain aspects of the law over time, so it’s really a work in progress.”
The ever-changing legal and medical landscape means Chirba and Noble can’t afford to rest on their laurels, because Health Reform will need updating every six months – and in fact, their editor is expecting the first revision shortly.
“I feel a sense of accomplishment,” says Chirba, “but I’m not going to sit back and enjoy it for very long.”