CHICAGO—Take it from the incoming president of the American Medical Association (AMA): the Affordable Care Act has flaws aplenty, but it’s moved health care forward in a way unseen since the 1965 creation of Medicare and Medicaid.

“The nation has been struggling to enact meaningful health system reform for more than a century,” AMA President-Elect Steven Stack, MD, FACEP, said in yesterday’s Colin C. Rorrie, Jr. Lecture at ACEP14. “But I would argue that we may have accomplished more in the last four years than in the preceding 40.”

Dr. Stack’s talk, aptly named “The ACA: The Rocky Road to Health Reform,” highlighted progress made in adding insurance coverage for millions of new people and protections of coverage for some 129 million patients with pre-existing conditions. But he emphasized that physicians—and others—need to realize insurance coverage is just one facet of the ACA.

“It’s also about improving quality and delivery functions, transitioning from a fragmented health care system with different providers and stakeholders operating largely independently to a collaborative, team-based approach, and shifting the focus of payment from quantity of service to quality of service.”

Emergency medicine veteran Ron Low, MD, MS, FACEP, of New York City Health and Hospitals Corp., was drawn to Dr. Stack’s talk by both interest in the varied impacts of the ACA, and his status as the first emergency physician to ever lead the AMA. Dr. Low said the talk reinforced for him how arduous the path to continued reform, and its ensuing improvements will be.

“I probably appreciate even more now that it’s going to be an unfinished thing for a while,” Dr. Low added. “It is frustrating but I don’t see any alternative, so I guess we’ll have to put our heads down [and keep working].”

In a brief question-and-answer session, Dr. Stack, an emergency department medical director in two states who currently practices in Lexington, Kentucky, told one nervous physician that even if Republicans take over Congress in next week’s midterm elections, he fully expects President Obama to veto any effort. In the meantime, emergency physicians need to step up and voice their concerns to be part of the process, he said.

“Our specialty must clearly articulate and define the role and value of our services in a reformed health care delivery system,” Dr. Stack added. “Emergency medicine in the future may look substantially different than today and we’ll have to adapt to survive and thrive.”

Richard Quinn is a writer in New Jersey.