All together, he believes the ACA should be beneficial to the community, but it “will not be as successful as it has been projected to be.”

Dr. William Fales is the Assistant Dean for clinical applications and

associate professor of emergency medicine at Western Michigan University’s new

medical school, Director of Emergency Medical Services (EMS) in Kalamazoo

County, and an emergency room physician. Dr. Fales carries out on-call emergencies

with EMS in addition to seeing and treating patients, typically those who have

benefited from insurance, in both Bronson and Borgess Hospitals. He is familiar

with the Affordable Care Act, but claims to be more indirectly involved,

encountering patients who “could or should be taking advantage of some of the

provisions of the Affordable Care Act.” He says that some have utilized these

provisions, but many have not. Beginning with this statement, he led into the

concept or framework of what the new law should do theoretically versus what may

happen in reality. He indicates that, despite efforts for enrollment through

advertisement and the free enrollment events, many individuals who probably

qualify for Medicaid or the new insurance exchanges are not aware that they do. In

Dr. Fales’ words, some patients “don’t know what [he’s] talking about” when he

mentions the Affordable Care Act and its provisions. In other circumstances,

individuals are aware of the Affordable Care Act, but they have not put in the effort

to obtain insurance, and there are other people who still cannot afford insurance. He

stated, “The Family Health Center and both hospitals did a decent job in trying to

help people, but I’m not sure that it was as effectively communicated to the

population that could have potentially benefitted.” As Dr. Fales indicated, the

provisions of the Affordable Care Act should ideally provide insurance to the

majority of Kalamazoo residents, but many remain unknowledgeable and

uninsured. This presents a problem because these people are unable to obtain

treatment beyond the emergency room.


Dr. Fales also mentioned the significant shortage of primary care providers

in the nation. Ideally, all individuals who become newly insured obtain a primary

care provider or a similar medical resource to promote health and address health

problems. In a response to a question regarding primary care, Dr. Fales stated, “[The

Affordable Care Act] should definitely increase the volume to primary care, but the

question with that is, do we have adequate primary care resources?” He stressed the

importance of educating more middle care providers, such as physician assistants

and nurse practitioners. A theme reiterated throughout the interview was the fact

that this law’s provisions are just starting to take effect. It is difficult to determine

right now how many people the Affordable Care Act will affect and how many

people will actually benefit from it. There may be unforeseen consequences or even

more benefits, but it will take many years to analyze the provisions of the Affordable

Care Act and observe the true, complete transitions undergone on the individual,

state, and national levels.


Despite the potential problems, Dr. Fales believes that if people take

advantage of primary care services, the community should become healthier. He

also mentions that the ACA will benefit his work; as he will be able to see more

insured patients who will be willing to receive primary care and specialist follow up.

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