Will the Patient Protection and Affordable Care Act stifle medical innovations?

In March 2010, the United States Congress and President Obama passed the Patient Protection and Affordable Care Act (PPACA) [1] to contain America’s medical costs [2].  Although this law passed, it was not by a bipartisan measure [3], and many Republicans believed that the American healthcare care should have been left unaltered.4  However, most understood that the status quo was not a viable option.  American health care costs were over 16% of GDP in 2010 and expected to be over 20% by 2020 [4].  The PPACA puts costs on a more sustainable trajectory.

While a majority of the U.S. population has health care insurance [5],  this does not translate into good health.  The Center for Disease Control (CDC) cites that the primary causes of disease as inactivity, tobacco use, excessive alcohol consumption, and poor nutrition [6].  Additionally, the CDC estimates that 70% of Americans deaths are due to preventable chronic diseases such as heart diseases, strokes, cancers, diabetes and arthritis [6].  The U.S. spends the highest of our Gross Domestic Product (GDP) of all industrialized nations on health care.  Estimated to be over $8,000 per person per year [7], but our health care ranking is lower than many other countries–at 37, which is lower than Singapore and Saudi Arabia [8].  This deficiency is particularly the case for infant mortality, where the U.S. ranks 29th in the world and is decreasing [9].

Despite the heavy spending we make, healthcare in our nation is not that good.  Are we spending wisely?  Clearly, one problem is that our healthcare system is not efficient and effective.  For example, the FDA has approved over 1,000 medications since 1990 [10], which amounts to almost 50 pills per year.  At the same time, those drugs would be unnecessary if Americans placed more emphasis on preventative care. These data suggest that patients cannot follow reasonable and proper preventive measures, or that healthcare providers are not offering this information.  In addition, the high number of new drugs requires time for healthcare providers to learn about these new medications in addition to a busy practice.

Inadvertently or by design, the U.S. healthcare system may reward ill health over good health due to strong economic incentives for providers.  An unhealthy population leads health-related companies to expand product offerings to treat disease.  Companies offering biologics were granted unlimited rights to manufacture their products without competition from generics.  For example, Humulin, available since the early 80’s, was one of only a few other brand-name products for human insulin.  With the passage of the PPACA, manufacturers of biologics now have a limited 12-year period before generic competition.

So, will the PPACA stifle medical innovation, as many cynics believe [12, 13]? The PPACA places more emphasis on preventative care and better therapeutics that are reasonable in cost.  The PPACA is not trying to block innovation but improves the quality of the American population.

In the past, poor health outcomes led innovation to new therapeutics. But, that was not helping the quality and longevity of Americans, or costs.  With the passing of PPACA, more American patients should take more interest in their health issues and aim for better outcomes.  A change in patient thinking and pressure to our healthcare industries will lead to more products related to preventative care.  Thus, innovation will not wither but be transformed to produce better tools for optimal health and quality of life with increased activity.  This type of thinking will foster our health care needs and lead to better more diagnostic and preventative biotechnology.

Innovations that contribute to better health (such as diagnostic tools that would improve the early targeted intervention) are badly needed.  Therapeutic tools are ever present and may have saturated the market, and hopefully, these will decline, and more diagnostic and preventative technology will be the center of our healthcare model.  The American researchers involved in medical innovations are primarily public funded academic intuitions, and this will not decline under the health care reform [14], like that of PPACA.  The PPACA is being gradually phased in and will be fully effective in 2018. This slow transition may help the current health care players to create better tools that achieve an improved health of our nation’s population.


1.  The Patient Protection and Affordable Care Ac. August 6, 2011 2009.

2.  Furrow BR. Patient Safety and the PPACA: Regulatory Torrents and System Liability. 2010.

3. Bovbjerg RR. Will the Patient Protection and Affordable Care Act Address the Problems Associated with Medical Malpractice? 2010.

4. Iglehart JK. Budgeting for change—Obama’s down payment on health care reform. New England Journal of Medicine. 2009;360(14):1381-1383.

5. Health Insurance Coverage. August 6, 2011 2011.

6. Chronic Diseases and Health Promotion. August 6, 2011.

7. Historical NHE, including Sponsor Analysis, 2009:. August 12, 2011.

8. The World Health Organization’s ranking of the world’s health systems. . August 12, 2011.

9. U.S. Ranks 29th in Infant Mortality. August 12, 2011.

10. NDA Approvals by Therapeutic Potential and Chemical Type. August 12, 2011.

11. Frank, R. G. (2007). “Regulation of follow-on biologics.” New England Journal of Medicine 357(9): 841-843.

12. Numerof, R.(2011). “Why Accountable Care Organizations Won’t Deliver Better Health Care—and Market Innovation Will. http://www.heritage.org/research/reports/2011/04/why-accountable-care-organizations-wont-deliver-better-health-care-and-market-innovation-will

13. Gross, L. (2010). “New Trends in Technology Assessment: Will Comparative-Effectiveness Research and Healthcare Reform Stifle Medical Device Innovation?” The Journal of Ambulatory Care Management 33(4): 350.

14.       The Prices of Pills.

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