New Health Law Is Sending Many Back to School

PROFESSIONAL development classes constantly need to adapt to new realities, and that is especially true now in health care management, with the Affordable Care Act changing the rules for patients, managers, doctors and other health workers.

Key provisions of the law, including the requirement that most people obtain health insurance and the creation of online insurance marketplaces where individuals can buy insurance, are leading to new policies and practices down the line. Confusion has inevitably ensued. But that could mean career opportunities for professionals with the best and most current understanding of the law and the way it is being put into practice.

The University of California, Los Angeles modified its certificate program in health care management, begun in 2005, in part to address the Affordable Care Act passed four years ago. That law has moved forward despite website problems, delays of various provisions, administrative exemptions and legal and congressional challenges.

The certificate program, part of U.C.L.A. Extension, includes topics like financial management, leadership, health law and compliance, marketing and technology. The class of 2012 had 235 students, according to the university. The eight-course program, which costs students about $7,200, is aimed at professionals and aspiring professionals in health care, insurance, government and the nonprofit sector.

The key elements in a course about health insurance coverage and payments are different now from what they were even several years ago, said Dylan Roby, an assistant professor of health policy and management in the university's School of Public Health. Now, for example, insurance companies cannot price people out of the market because of pre-existing conditions, he said. In classes, 'You have to explain what happened and what's changed,' he said.

Professor Roby created the introductory course in a new online-only certificate program for medical professionals - including doctors, nurses, managers and administrators - called Transformational Leadership in Health Care, which considers various facets of the new health law. That program, which began a year ago, costs around $7,000.

Two years ago, U.C.L.A. Extension also started a certificate program in patient advocacy - on campus and online - as more people take jobs helping patients and their families navigate a maze of treatment and billing issues. That certificate costs about $5,600.

Professor Roby said the U.C.L.A. programs were intended to be pragmatic. Although he says he personally thinks the Affordable Care Act 'is a step in the right direction and does make it much easier for people to obtain comprehensive insurance coverage,' the coursework also looks at 'potential failures and what the A.C.A. does and does not do to solve them.'

'You're flying by the seat of your pants with the A.C.A.,' said Lisa Labellarte of Los Angeles, who finished the university's patient advocacy program last year. In 2012 she started a patient advocacy company called Sequoia Health Advocates in Los Angeles. Her son, now 13, was born with medical problems and her sister developed breast cancer. Ms. Labellarte became an advocate for them, which evolved into wanting to go into business to do the same for others.

As an example, she said, she helped an American who lived outside the United States obtain insurance through the California marketplace so he could return to this country for medical treatment - a process that proved to be difficult and required up-to-date knowledge of the law.

Ms. Labellarte has found that some of what she learned in the patient advocacy program, especially about insurance, is now outdated. For that reason, she and others have talked with administrators of the program about what to include in future classes as the new health law continues to play out.

She and others in health care sometimes face difficult ethical questions about treatment and coverage. The new law is affecting the very nature of the quandaries that arise, said Robert Klitzman, director of the masters of bioethics program at Columbia University, run through the School of Continuing Education. He has had to alter the program as a result.

Questions his program now addresses include: Does the government have the right to demand that people buy health insurance, and should they be penalized if they don't? What is a minimal level of care? How do you allocate scarce resources? How do you prevent cost overruns? Should the government provide infertility treatments under the new law, or should that be considered an elective service and, if so, for whom? How much should the government oversee drug companies? The list goes on.

Issues like these have become concrete in a way they never were before, said Professor Klitzman, a psychiatry professor at the Columbia College of Physicians and Surgeons and the Mailman School of Public Health.

The M.S. program costs around $60,000, with federal loans available. Students include working professionals who are in the health field or seeking to enter it, he said. Pre-med students sometimes do the coursework after graduating and before applying to medical school, he said.

He also set up online bioethics courses and a certificate program, which started a year ago. The certificate program costs about $20,000, but classes can also be taken individually and without credit for as little as around $1,650 each. Students can receive continuing medical education credit for the courses.

Professor Klitzman says he personally thinks that the Affordable Care Act has many positive aspects, particularly because it helps people who are uninsured and underinsured, but he does not see it as a solution to the nation's health care problems. The program itself looks at the law's pros and cons and brings in speakers on both sides of the issue, he said. Any policy that addresses a complex social problem will result in unintended consequences and trade-offs, he said, and health care workers need to be aware of them.

Katherine Zavin, a student in the bioethics program, took a class through Columbia Law School called Access to Health Care, which focused on the Affordable Care Act. 'The best part of the course was that since many aspects of the A.C.A. were going into effect while the course was going on, we talked about political reactions and possible legal reactions in current time,' she said in an email.

'Bioethics gives you a structure to understand what's going on in the bigger picture,' Professor Klitzman said. 'We need to equip our students to work in this rapidly evolving world.'

Correction: March 18, 2014