Reardon 1

1


Meredith L. Reardon
Dr. Nora Bird
LIS 620
16 April 2012
Health Care Reform and the Affordable Care Act: A Reference Search
Introduction
I was recently approached by a health-care professional with an information need. I will refer to
this patron as Mr. Smith throughout this report. Mr. Smith is a local pharmacist who is interested in
knowing more about health care reform and the Affordable Health Care Act. He stated that he has heard
a lot of conflicting information about this law in media and wanted more information so he would be
able to draw his own conclusions. Because of the partisan political nature of this topic I knew the search
could pose a challenge.
Reference Interview
In the interview Mr. Smith specified he wanted to learn more about health care reform and the
Affordable Care Act. In an attempt to clarify his information needs I began to ask a series of questions.
His information need seemed to be of a personal nature so my first task was to clarify this. I asked him
What is the information for? Is this for personal use or will it be used academically or professionally?
As I suspected it was only for personal enrichment. From here I wanted to know what formats he would
be comfortable with. I asked him if both print and electronic sources where acceptable and he indicated
yes. I then inquired about the types of sources he was comfortable with. Since Mr. Smith has a
Reardon 2

2

doctorate I was sure his reading level was adequate for reading any type of source I would provide.
However I did want to ensure that he was comfortable with both scholarly journal articles and also legal
documents such as the legislation itself. He stated that he was comfortable with anything I could throw
at him.
Now that I had clarified the technical parameters of the pending search I began to ask more
probing questions. I knew that Mr. Smith said he was looking for general information but I suspected
that he also wanted to answers to more specific questions. I stated that health care reform has a long
history and asked if he was interested in previous attempts at reform or if he was only interested in its
current state. He responded that he was somewhat interested in the history of health care reform but
that his main focus was the current legislation. Lastly, I asked him if there were any specifics in relation
to health care reform and the Affordable Care Act that he wanted me to investigate. He replied that he
was curious to know if the law would affect the pharmacy profession. With all of my questions answered
I set out to provide Mr. Smith with a comprehensive overview of the legislation as well as the specifics
he requested.
Search Diary
Before starting the search I was concerned about the partisan nature of the subject and how it
would affect my search. While I dont know Mr. Smiths politics I do know that many of those writing
about this topic have a political agenda. I have taken great care to provide sources which both support
and criticize the legislation in an attempt to be unbiased. I also made it clear to Mr. Smith that much of
this information may be biased and that he should make his own conclusions based on the information
as a whole.
My first step was to look for information provided by the U.S. Government about the law. I felt
that government sources can be considered trustworthy. I performed a Google search of the phrase
Reardon 3

3

Affordable Care Act and restricted the results to domains ending in .gov. Through this method I found
HealthCare.gov. This is a government run website that provides a great deal of information about the
Affordable Care Act. Under the The Health Care Law & You tab there is an option to read the law in
its entirety, see key features of the law and view a timeline of changes as well as other options. Since
this website has a lot of information I encouraged Mr. Smith to thoroughly explore and review the site
pointing out particular items of interest.
While HealthCare.gov provided a great overview I knew that it would not include any criticism of
the Affordable Care Act. It would only show the legislation in the most favorable way possible. I felt that
I should look for some sources such as books or articles that can provide some commentary and context
on the topic. I decided to search the Charlotte Mecklenburg Public Library Systems Catalog to see what
they had to offer. This is Mr. Smiths local library system and he would have easy access their catalog.
I first searched the phrase health care reform which provided 219 results in a variety of
formats. Those formats included books, government documents, microfiche, eBooks, a graphic novel
and a movie. While we did not discuss the possibility of having microfiche as a format I quickly browsed
the content and it was clear that it was dated material. I knew that I wanted to only use sources
published no earlier than 2010, the year the Affordable Health Care Act was signed into law. So I
adjusted the search results accordingly. I also browsed the government documents most of which were
committee hearings on specific topics that would not be relevant to Mr. Smiths request. It was among
the books and eBooks that I found sources that I thought would be relevant to Mr. Smiths information
need. Interestingly enough I also found an adult graphic novel that explained the Affordable Health Care
Act. I thought this could be a fun and interesting source to explore.
While the previous search did lead me to sources related to health care reform it did not
provide sources that were solely focused on the Affordable Care Act. This led me to perform another
Reardon 4

4

search, this time using the phrase Affordable Care Act. This search results were considerably lower
than with the previous search. There were a total of 17 results with 13 being government documents
and 4 being books. Once again the government documents were not relevant to Mr. Smiths information
need; however the books were exactly what I was looking for.
At this point I felt like I had enough general information on health care reform and the
Affordable Care Act. I began to shift the search to look for how the Affordable Care Act will affect the
pharmacy profession. I thought that the best place to look for this information would be in academic
journals and periodicals. My plan was to search databases such as CINHAL Plus, PubMed and Academic
Search Complete for these sources.
The first database I tried was CINHAL Plus with Full Text. This database covers allied health
literature which includes many pharmacy related journals. CINHAL is an EBSCO database which has a
search interface I am very comfortable using. I used the Boolean/Phrase search mode with search terms
Affordable Care Act AND pharmacy. This did not provide any results which I did not expect. I then
adjusted my search terms to Affordable Care Act AND pharmacist and again got no results. At this
point I thought to use the apply related words option. This gave me one result and it happened to be
exactly what I was looking for.
After having little success using CINHAL Plus I decided to try out the database Academic Search
Complete. Academic Search Complete is a multidisciplinary database with pharmaceutical science being
a topic it covered. It is also an EBSCO database so I used the same search strategy that I used on the
previous database. I used the Boolean/Phrase search mode with the search terms Affordable Care Act
AND pharmacy. This time I chose the option to apply related words before I started. I received 31
results, several of which were relevant to Mr. Smiths information need. Just as I had with CINHAL Plus I
adjusted my search to Affordable Care Act AND pharmacists while choosing to apply related
Reardon 5

5

words. This time I received 22 results, many of the articles overlapped with the previous search results.
Despite the overlap I was still able to find a few new articles that were relevant to my search.
At this point in my search I have had to clear a few hurdles. I found an article which was not
available to me in full-text. Based on the abstract provided it appeared that this article was exactly what
Mr. Smith was looking for. I considered not using the article but I wasnt ready to give up on it just yet. I
remembered that Mr. Smith had mentioned he had access to the Charlotte AHEC Library so I thought
that he may be able to access the article there. The article was in the journal Pharmacotherapy so I
checked AHECs journal holdings and they did have access. Therefore I decided to refer Mr. Smith to
AHEC if he wanted access to this particular article. Also while I was searching these databases I noticed
that most of the articles seemed to take a positive stance toward the Affordable Care Act. I did find two
opinion articles from the Pharmacy Times which had a more negative view of the legislation. I felt it was
important to include this in my search results in an attempt to be impartial and balanced in my search.
The last database I searched was PubMed which I had never used before. I quickly reviewed the
tutorial and found that PubMed allows Boolean logic and also automatically searches for phrases. This
allowed me to use the same method that I had employed with two previous databases. My search terms
were Affordable Care Act AND pharmacist which returned a total of 7 results. When looking at the
results I quickly realized that I was not going to have access to the full-text version of the relevant
articles. Once again I cross referenced the Charlotte AHEC librarys journal holdings and found that Mr.
Smith could still have access to these.
Over the few weeks that I was searching the Affordable Care Act became the center of media
attention again. This is due to the fact that the legislation was going in front of the Supreme Court to
decide its constitutionality. I had been tempted to provide some information about this to Mr. Smith
but it was not what we discussed. I very much expect that Mr. Smith will have questions about this when
Reardon 6

6

I send him my findings. In my final communication I will let him know that I will be more than happy to
provide this information if he wishes.
Note to Patron
I have completed my research on health care reform, the Affordable Care Act and what it means
for the pharmacy profession. I was easily able to find information on all aspects of your topic and have
delivered a wealth of information to you. Overall I have provided eighteen different sources regarding
your inquiry. Please refer to the bibliography to see relevant information on each source as well as an
abstract or summary of each. I also want to remind you that this is an extremely partisan subject and it
is likely that some of these sources political leanings are either far left or far right. I have provided
sources from both sides so that I can provide you complete and unbiased results. Please keep this in
mind when reviewing the literature.
I first recommend that you visit HealthCare.gov, the United States Governments website about
the Affordable Care Act. Here you can read the legislation in its entirety if you wish. You can also read
about key features of the law, a timeline for changes and find out what it means for certain groups of
people. This website has a lot to offer so take some time to explore it.
While HealthCare.gov is an excellent source it is unlikely to provide an unbiased review of the
law. Therefore I have provided four books for your consideration. They are general overviews of health
care reform, the Affordable Care Act or both. In case you are looking for something a little different I
have also included an adult graphic novel that details the Affordable Care Act. All of these titles are
available to you through the Charlotte Mecklenburg Public Library System.
Lastly, I have provided information on twelve articles which detail the Affordable Care Act and
what it means for your profession. These articles come from both scholarly journals and trade
Reardon 7

7

publications related to pharmacy. I can provide the full-text of all these articles except those by
Carpenter, Lipton and Matzke. These three articles are available to you through your access to
Charlottes AHEC Library. I have ensured that their collection covers these three articles. It is also likely
that you would also have access to the others through AHEC; however I have not verified this.
Once again the Affordable Care Act is in the news because of questions about its
constitutionality. Since this developed after our initial conversation on what information you were
looking for I did not include it in my search. If this is something you are interested in finding our more
about please let me know. Also if the information I have provided does not meet your needs or you have
any other questions please feel free to contact me.
Bibliography
Aston, Geri. "PHARMACISTS STEP UP." H&HN: Hospitals & Health Networks Feb. 2011: 33-
36. Academic Search Complete. Web. 10 Apr. 2012.
The article reports on an increase which is being seen in the level of involvement which hospital
pharmacists in U.S. hospitals are taking in the care of hospital patients. A discussion of the
impact that the U.S. Patient Protection and Affordable Care Act will have on the role that
hospital pharmacists play in the care of hospital patients is presented.


Barlas, S. "New Directions for Health Care Law in the U.S.: Emphasis on Preventive, Holistic
Therapies Offers Possibilities for Pharmacists." P&T: Journal for Formulary
Management 35.5 (2010): 270+. CINHAL Plus with Full Text. Web. 5 Apr 2012.
The passage on the Patient Protection and Affordable Care Act represents an opportunity to
begin repairing parts of our health care system. For example, pharmacists might be able to
expand their scope of practice and become more involved with patients and
prescribers. However, several roadblocks, including a lack of funding and some ambiguous
congressional language, must first be overcome.


Reardon 8

8

Carpenter, Laura A., Zachary Edgar, and Christopher Dang. "Pharmacy Waste, Fraud, and Abuse in
Health Care Reform." Journal of the American Pharmacists Association 51.2 (2011): E3-
E16. PubMed. Web. 12 Apr. 2012.
OBJECTIVE: To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of
the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability
Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R.
4872, and applicable existing and proposed regulations.
SUMMARY: Waste, fraud, and abuse are substantial threats to the efficiency of the
health care system. To combat these activities, the Department of Health and Human Services
and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the
proper assessment and billing for Medicare and Medicaid services. These guidelines have a
number of provisions that can catch even well-intentioned providers off guard, resulting in
substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws
and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to
apprise pharmacists of the substantial changes affecting their practice.
CONCLUSION: H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify
liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and
Stark Law; and create or extend auditing and management programs. Properly navigating these
changes will be important in keeping pharmacies in compliance.

Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA:
Stanford Business, 2010. Print.
Health care is, arguably, the most hotly debated topic since Barack Obama took over the
presidency. Perspectives on the future of our system echo through the halls of Washington and
in the living rooms of Americans. This book takes a close look at our problems, proposes how to
solve them, and explains how to navigate our political system to effect positive change, and
provides a thorough understanding of the forces that have produced the monumental problems
that we face in health care today. Then, he makes a compelling case for overhauling our system,
offering six elements that should be included in any plan for change. To begin, everyone must
have insurance. Individuals and employers would pay a premium or tax earmarked for this
purpose to a federal agency. Using the tax system is the simplest way to collect the money, and
progressive rates are the fairest way for individuals and businesses to pay. Critically, the
amounts that individuals and employers pay would be independent of health status. Insurers
and health care plans must accept anyone who wants to enroll. But payments to them would be
risk adjusted to protect them against adverse selection. Finally, patients' out of pocket
payments must be limited so they can really access the services they need, and providers can
make decisions based only on what procedures are appropriate. The author charts potential
compromises to these six elements and the effects of those concessions, outlining a realistic
political strategy. Whatever compromises are accepted, the underlying goal of reform must be
to change incentives for all players who participate in the system. This goal cannot be achieved
Reardon 9

9

if we rely solely on market based solutions. This book argues that only a solution with a large
public sector role can lead us to real reform. Based on the his 30+ years of studying and teaching
about the U.S. health care system, this book provides clear and comprehensive tools to improve
our declining health care system (Summary from WorldCat.org) Note: also available as an eBook

Gruber, Jonathan, and H. P. Newquist. Health Care Reform: What It Is, Why It's Necessary, How It
Works. New York: Hill and Wang, 2011. Print.
You won't have to worry about going broke if you get sick. We will start to bring the costs of
health care under control. And we will do all this while reducing the federal deficit. That is the
promise of the Affordable Care Act. But from the moment President Obama signed the bill into
law in 2010, a steady and mounting avalanche of misinformation about the ACA has left a
growing majority of Americans confused about what it is, why it's necessary, and how it works. If
you're one of them, buy this book. From how to tame the twin threats of rising costs and the
increasing number of uninsured to why an insurance mandate is good for your health, Health
Care Reform dispels false fears by arming you with facts. (Summary from plcmc.org)


Hennessy, Mike. "HEALTH CARE REFORM: A SECOND CHANCE TO GET IT RIGHT."Pharmacy
Times Nov.2010: 16. Academic Search Complete. Web. 10 Apr. 2012.
The author comments on the U.S. Patient Protection and Affordable Care Act (PPACA). He
asserts his opposition to provisions of PPACA on its effects to health care professionals and
patients. He argues that though the PPACA will expand the power and influence of the U.S.
government since Medicare, it will not be a true reform. He highlights that the U.S. government
will interfere in business affairs of health care professionals and in patient-provider relationship.

Hennessy, Mike. "OBAMACARE: WHAT DOES IT MEAN FOR THE PHARMACIST?"Pharmacy
Times Oct. 2010: 14. Academic Search Complete. Web. 10 Apr. 2012.
The article comments on the effect of the Patient Protection and Affordable Care Act (PPACA)
on U.S. pharmacists. The law aims to reduce the reimbursements to physicians and enhance the
efficiency of care delivery across the board. According to the author, this will decrease the
budget allotted by the federal government for Medicare by around 565 billion U.S. dollars from
2011 to 2021.


Reardon 10

10

Khani, Julie, and John Costner. "Health Care Reform's Impact on Community Pharmacy."Pharmacy
Times Apr.2010: 55. Academic Search Complete. Web. 10 Apr. 2012.
The authors discuss the impact of the Patient Protection and Affordable Care Act on
community pharmacy in the U.S. It provides a summary of issues affecting pharmacy and a
timeline of when the changes will take effect. The key issues include Medicaid generic
drug pharmacy reimbursement and the exemption of pharmacists from Medicare durable
medical equipment (DME) accreditation. The health reform law's medication therapy
management (MTM) grant program is also cited.

Lipton, Helene Levens. "Pharmacists and Health Reform: Go for It!" Pharmacotherapy30.10 (2010): 967-
72. Print.
The author discusses the effect of the U.S. health reform law Patient Protection
and Affordable Care Act on pharmacists. She claims that the law will enable pharmacists to
demonstrate the profession's capacity to promote public health in the country. She discusses
five health care programs where pharmacists could show their expertise, including medical
homes, medication therapy management (MTM), and accountable care organizations (ACOs).


Matzke, G. R. "Health Care Reform 2011: Opportunities for Pharmacists." The Annals of
Pharmacotherapy 46.4 (2012): S27-32. PubMed. Web. 12 Apr. 2012.
The health reforms of the last several years at the federal and state levels have created many
opportunities for pharmacists to become actively involved in the direct patient care provision.
Indeed, the statutory language in some sections of the Affordable Care Act of 2010 creates
expectations of pharmacists that will require practice transformation if we are to arise to accept
the responsibilities associated with these expectations. These new opportunities open the door
for pharmacists to benefit community-dwelling patients with chronic medical conditions, those
with acute/emergent care needs, those experiencing a transition between chronic and
acute care and vice versa, as well as others in long-term care settings. Although the profession
has demonstrated value in many practice environments, our contributions to improved
medication-related patient outcomes through medication therapy management (MTM) and the
other pharmaceutical care services remain to be rigorously quantified. Incorporation
of pharmacists either by their physical presence within the practice or through the design of
effective community linkages, such as electronic health records, must be developed to meet the
needs of rural and urban patients seen in a variety of practice settings. New business models
that build upon cognitive and direct patient care services in addition to the provision of drug
products will surely need to emerge for the profession to become a viable and vital component
of the US health care system.
Reardon 11

11



Nather, David. The New Health Care System: Everything You Need to Know. New York, NY: Thomas
Dunne, 2010. Print.
Now that the health care reform bill has become the law of the land, millions of Americans will
need help figuring out exactly how the new system will work and how it might affect their lives.
This guide will teach people how the new health care exchanges are supposed to work. In an
easy, conversational manner, David Nather makes a complicated system easier to understand by
answering all your questions. Such as:. *How to apply for help in paying for insurance? *Will
your healthcare change if you work for a big company or a small company? *How will the
legislation affect you if you receive individual insurance, if you're uninsured, or if you are on
Medicare? *What new protections are you supposed to get from the worst health insurance
practices? *Why did Congress decided everyone should be required to get health insurance? For
people who aren't lawyers or policy wonks, but simply want to make sense of what to expect in
their own lives, this book will be a must-read. (Summary from plcmc.org)

Roberts, Bruce. "Aiding Pharmacists." Modern Healthcare 26 Apr. 2010: 20. Academic Search Complete.
Web. 10 Apr. 2012.
The author discusses the potential benefits of the healthcare reform law provisions. The Patient
Protection and Affordable Care Act provisions of the new healthcare reform law are expected to
help community pharmacists and patients. The provisions include reasonable Medicaid
reimbursement for generic drugs, no more coverage gap in the Medicare drug benefit and
limited disclosure requirements for prescription drug middlemen.


Starr, Paul. Remedy and Reaction: The Peculiar American Struggle over Health Care Reform. New
Haven: Yale UP, 2011. Print.
In no other country has health care served as such a volatile flashpoint of ideological conflict.
America has endured a century of rancorous debate on health insurance, and despite the
passage of legislation in 2010, the battle is not yet over. This book is a history of how and why
the United States became so stubbornly different in health care, presented by an expert with
unsurpassed knowledge of the issues. Tracing health-care reform from its beginnings to its
current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap
through policies that satisfied enough of the public and so enriched the health-care industry as
to make the system difficult to change. He reveals the inside story of the rise and fall of the
Clinton health plan in the early 1990s--and of the Gingrich counterrevolution that followed. And
he explains the curious tale of how Mitt Romney's reforms in Massachusetts became a model
Reardon 12

12

for Democrats and then follows both the passage of those reforms under Obama and the
explosive reaction they elicited from conservatives. Writing concisely and with an even hand,
the author offers exactly what is needed as the debate continues--a penetrating account of how
health care became such treacherous terrain in American politics. (Summary from plcmc.org)

Tally, Richard C. "Prescribing Authority for Pharmacists." American Journal of Health-System
Pharmacy 68.24 (2011): 2333. Academic Search Complete. Web. 10 Apr. 2012.
The author reflects on the history of pharmacist prescribing in the U.S. and suggests that the
current health care crisis and federal spending cuts could expand such opportunities. He notes
that while the Patient Protection and Affordable Care Act indirectly provide for pharmacists'
recognition as health care providers, further advocacy is needed to bring about change. He
believes that pharmacists engage in collaborative practice prescribing and billing agreements
with physicians.


Thompson, C. A. "New Health Care Laws Will Bring Changes for Pharmacists."American Journal of
Health-System Pharmacy 67.9 (2010): 690-95. Academic Search Complete. Web. 10 Apr. 2012.
A summary is presented of the Patient Protection and Affordable Care Act and the
Health Care and Education Affordability Reconciliation Act of 2010, signed into law by the U.S.
President Barack Obama on March 23 and 30.


Traynor, Kate. "Health Care Reform Means Challenges, Opportunities in Rural Areas."American Journal
of Health-System Pharmacy 68.2 (2011): 102-04. Academic Search Complete. Web. 10 Apr. 2012.
The article reports on the health care reform in rural America, in which it is about providing
better and cost-efficient care. It says that pharmacists ensure correct drug selection for patients,
measure quality outcomes, and use health information technology to monitor patient care in
the period of health care reform. It also mentions that the Affordable Care Act gives benefits for
rural practitioners such as the expansion of the National Health Services educational-loan
forgiveness program.


United States Government. "HealthCare.gov." HealthCare.gov. Managed by the U.S. Department of
Health & Human Services. Web. 25 Mar. 2012. <http://www.healthcare.gov>.
Reardon 13

13

This website provided by the United States government is a one stop shop regarding health
care. It has many functions including finding insurance, getting help using insurance, comparing
care providers, prevention and wellness and information on the health care law and you. The
tab titled The Health Care Law & You provides access to the full-text of the Affordable Care
Act as well as information about its key features, how it will affect you and a timeline for its
changes.

Washington Post Staff. Landmark: The inside Story of America's New Health Care Law and What It
Means for Us All. New York: Public Affairs, 2010. Print.
The Washington Posts must-read guide to the health care overhaul What now? Despite the
rancorous, divisive, year-long debate in Washington, many Americans still don't understand
what the historic overhaul of the health care system will-or won't-mean. In Landmark , the
national reporting staff of The Washington Post pierces through the confusion, examining the
new law's likely impact on us all: our families, doctors, hospitals, health care providers, insurers,
and other parts of a health care system that has grown to occupy one-sixth of the U.S. economy.
Landmark 's behind-the-scenes narrative reveals how just how close the law came to defeat, as
well as the compromises and deals that President Obama and his Democratic majority in
Congress made in achieving what has eluded their predecessors for the past seventy-five years:
A legislative package that expands and transforms American health care coverage. Landmark is
an invaluable resource for anyone eager to understand the changes coming our way. (Summary
from plcmc.org)