Another aspect of the law is the organization of accountable care organizations, or ACOs, which are designed to benefit both Medicare patients and people who are privately insured. ACOs establish one party – a hospital, say, or a primary care provider – responsible for coordinating care, explains Sood. “People with chronic conditions often have a variety of illnesses and various providers. Coordinating with a single provider can benefit patients in terms of improving health and reducing cost,” he says, noting that private plans are already experimenting with ACOs, but it may take a few years for ACOs to catch on.

Easing Individual Costs

Supporters say the law also will help slow health care’s drain on pocketbooks. “No one, including those with chronic conditions, will have to worry about lifetime caps on coverage or annual coverage limits,” says Sood. And as of 2014, there will be caps on how much people have to pay out of pocket. The caps will be based on a sliding scale, depending on income.

“This is all good news,” says Karen Siegrist, 56, a nurse practitioner in St. Louis, Mo., who has had psoriatic arthritis for a decade, and OA for five years. “I get 100 percent coverage through my employer, but I’ve worked with families who have capped out of insurance plans and lost their homes. This will help protect people from that.”

The law also addresses the “doughnut hole,” or gap in prescription coverage under Medicare. Before the ACA passed, Medicare patients paid 25 percent of drug costs until they had spent $2,800, then they had to pay full cost until they had spent $4,550. Since 2011, patients formerly in the doughnut hole have had prescription costs lowered by 50 percent as a result of the law. By 2020, the doughnut hole for brand-name and generic drugs will cease; patients will pay 25 percent of the cost of drugs until they reach their yearly cap on out-of-pocket spending.

“The doughnut hole was something I was really worried about,” says Wyatt, noting that the retail cost of some biologic drugs are $3,000 a month. “I’ve been on biologic medications for eight years, and the costs are not going down. Many patients have to pay a high percentage of that cost. I had a real fear that if the national mandate was not recognized, insurance companies could go back to cherry-picking what benefits they wanted to support.”

Help for The Littlest Patients, Too

The law also aims to encourage future doctors to go into underserved subspecialties – like pediatric rheumatology – by creating a loan repayment program. “Some people have to wait six months to see pediatric rheumatologists,” says Siegrist, whose son developed psoriatic arthritis at age 17 and epilepsy at age 20. The loan forgiveness amount for doctors can be as high as $120,00 in return for up to three years of service in an underserved specialty.

Medicaid Expansion Up in the Air

Another controversial part of access to care law is its requirement for Medicaid to expand to include a greater proportion of low-income earners or lose federal funding. The Supreme Court ruled that it is constitutional for Congress to offer states funds to expand Medicaid coverage to millions of new individuals. States would agree to expand coverage in exchange for new federal funds, and if a state accepts the funds, it must obey the new rules. However, the court also ruled that the federal government cannot withhold all Medicaid funding to states that decline to expand Medicaid. “What states will do is an open question,” says Sood. Prior to the Court’s ruling, 26 states had challenged that provision.

Field agrees. “The effect of the ruling on the Medicaid expansion is yet to be seen,” he says. “States will be able to opt out of the expansion without losing all of their federal Medicaid funding. Time will tell how many states choose to do this.”