Patient Protection and Affordable Care Act: implications for pediatric plastic surgery

Passage of the Patient Protection and Affordable Care Act (PPACA) has stimulated wide debate in the medical and surgical community. Endorsed by the American Medical Association and a number of primary care-focused organizations, the American College of Surgeons (ACS) and nearly all other surgical associations opposed the bill. This divergence stems not from direct disagreement over provisions in the bill but from opposition to or support of certain provisions with direct implications for the physicians represented by a given organization, as well as the relative importance of provisions for which these organizations share a common opinion. Regarding the field of pediatric plastic surgery, the surgical perspective of the ACS and the American Society of Plastic Surgeons and the medical perspective of the American Academy of Pediatrics align on many issues. Given the lack of specificity of any of the provisions for a field as specialized as pediatric plastic surgery, this review will focus on broader implications of the PPACA both for medical and surgical needs of pediatric patients and for the surgeons providing their care. The provisions of the PPACA are distributed along an implementation timeline, with some major changes having already occurred. The popularity of some of the early provisions, many pertaining to the pediatric population, has implications for any attempt at repeal of the law as a whole in coming years. Despite its daunting length, the PPACA can be approached by considering its provisions in 4 major categories: increased consumer protections, increased accountability for insurers, increased access to affordable care, and quality and cost improvement.