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Patient Protection and Affordable Care Act (PPACA): Effect on the Fastest Growing Population, the Elderly

President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA), generally called the Affordable Care Act (ACA), into law on March 23, 2010. It is probably the most important piece of healthrelated legislation since the enactment of Medicare and Medicaid in 1965. In this chapter, we explore the ACA and its potential impact on the elderly surgical population. This review is important since, in 2013, 3 years after the advent of ACA, >1 in every 8 Americans is 65 years of age or older. In the United States, this age group represents 13.3% of the population, representing 41.4 million Americans. These are staggering data, especially when compared with historic numbers of 4.1% in 1900 when the same group numbered 3.1 million. More importantly, it is predicted that the growth of the elderly population will continue to skyrocket. Since 2000, there was an 18% increase in this cohort, which was nearly double the growth of the population under 65 years of age (9.4%). By 2040, this population will nearly double again (Fig. 1). Remarkably, the oldest of the aged is where the greatest change is seen. When compared with the population of 1900, the 65 to 74 age range is 10 times as large, the 75 to 84 age range is 16 times as large, and the above 85 age range 40 times as large. Providing affordable quality health care to this expanding population is salient and challenging not only because of their sheer numbers, but also because this is the subset of the population that requires the most care, and therefore uses the most health-care dollars.