The Affordable Care Act, better known as Obamacare, has been a lightening rod for controversy at both the national and state level. In Maine, the biggest political battle has been over Medicaid expansion, but consumers also voice concerns over insurance plan costs, mandates, and penalties.

However, the ACA is not all about insurance. There are other reforms that don’t meet the public eye and are profoundly affecting the way that you experience health care. Some of these requirements appear heavy-handed, but if you look under the hood, you see some real change happening.

For example, the ACA has accelerated the technological revolution in doctors’ offices. Electronic medical records were an innovation before the ACA was passed, but the act ramps up financial incentives to embed electronic records into care. They can initially be clumsy, difficult to use, and costly in clinician time, but they are helping doctors’ offices make great leaps in care.

There’s an automatic reminder function in electronic records that informs doctors about which patients need such things as follow-up appointments, blood pressure screens, immunizations and lab tests. Perhaps now my doc will be as good as my vet at reminding me about annual screenings!

The EMR allows clinicians to look more closely at success and failure because they can capture group data on patients. They can ask, “Are we really making a difference with our diabetic patients? Where in the treatment plan are we falling down?” In the past, they couldn’t sort through hundreds of paper-based charts to look at care outcomes.

You may have noticed something else that’s new at your doctor’s office. Patients must now leave the visit with patient plans — written summaries of the diagnosis, therapy plans, and medications. The ACA encourages, even compels, providers to give more information to patients.

Clinicians are now realizing how much they expected their patients to remember during a hurried visit when complicated instructions were being thrown at them rapid fire. How many of us have brought a second person to a doctor’s appointment just to make sure that we heard everything?

There are also handy written health education materials that doctors can generate on the spot from their electronic records to complement their instructions. The records make it easier and easier to do the right thing, and that’s a win for both the clinician and the patient.

The ACA has also been steering health care away from fee-for-service payments (the more procedures you do, the more money you get) toward payments that reward clinicians for keeping their patients healthy. In some cases, doctors actually get to keep a share of the cost savings achieved by focusing more on health. These are tectonic shifts, moving us away from a “sick care” system to an actual “health care” system.

Hospitals are also expected to get more deeply involved in community health. The ACA expanded what are known as “community benefit” requirements for nonprofit hospitals that get federal tax exemptions. Why would organizations at the top of the food chain in “sick care” — hospitals — be required to develop wellness efforts in their cities and towns? Here’s why: hospitals have long received tax exemptions because they provided charity care to low-income patients. But with expansion of public coverage under Obamacare, there should be less demand by uninsured patients for free and discounted hospital care. Some of those “saved” hospital resources should therefore be channeled to prevention efforts in the community.

Did those savings really happen? The Kaiser Commission on Medicaid and the Uninsured looked at health data comparing Medicaid expansion states to states with no Medicaid expansion. In states choosing to expand Medicaid under the ACA, hospitals saw a 40 percent reduction in charity care, versus a 6.2 percent drop in states without Medicaid expansion (like Maine). Maine hospitals have actually complained that their charity care costs have skyrocketed, citing the state’s unwillingness to expand Medicaid as a major culprit.

Nevertheless, Maine hospitals are doing their part. They continue to provide free care, and many are pursuing community prevention efforts such as dental health programs, childhood obesity prevention, aging-in-place services for seniors, and substance abuse interventions, to name a few.

We will continue to see battles in the Maine Legislature this session about expanding Medicaid. Congressional opponents of Obamacare will continue their futile call for repeal. Remember though, Medicare was equally controversial when passed 50 years ago. It has since been tweaked and improved repeatedly over the years and is now an important part of Americans’ lives.

The Affordable Care Act is also becoming an important part of our lives. We need the two sides down in Washington to reach across their ideological divide and work to make gradual, needed improvements to the ACA because it is here to stay.

Lisa Miller, of Somerville, is a former legislator who served on the Health and Human Services and Appropriations and Financial Affairs committees.

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