Kim Mansch works with the uninsured.  She supports the act’s mandate for increased preventive care.  After all, a problem is easier to stop than to solve.  The ACA mandates top preventive tests like pap smears, yearly screenings for children, even flu shots be free -- no co-pay.  It’s not cheap.  The average price of a colonoscopy is $1,100.

"Individuals will have the ability to access care and access their physician prior to their health care situation or problem becoming a crisis.  So that is going to directly lead to more positive outcomes, as well as a positive reduction in the overall health care costs for the entire system," Mansch explains.  

Some patients are optimistic.  Phillip Stauffer of Missoula says, "I think it will bring better health care."

Some disagree.  Neurologist Carter Beck is not a fan of the Affordable Care Act. 

Beck insists the act supports a cookie-cutter approach to medicine that has been growing across the country already.  "It's sort of an ‘all of us are in it together’ philosophy.  That means the individual's particular needs might be neglected.  What we end up doing is treating populations based on statistics, based on averages.  I don’t think that’s what a patient expects when they come to the office," Beck explains.

He points to his patient Leann Schaf to make his case.  Schaf says that cookie-cutter approach has cost her a procedure that was right for the type of pain she is experiencing. 

"It just kind of puts an end to my life almost, and the activities that I want to do," says Schaf.  

Beck wanted to do two procedures in one surgery to help Leann.  Her insurance said no way.  Instead, she’ll have two separate procedures. 

For Beck, that shows a non-individualized approach to health care. He tells us, "So instead of the old model of a doctor who came to town and was the quintessential small businessman in town, who spent his life and his career in a particular location, we're going to have doctors provided by a big company. Imagine AT&T or Verizon deciding who the doctor is going to be that day. I think that is the direction we are headed -- the corporatization of America."

Beck would rather be the employer than the boss.  He’s negotiating with a hospital to join its staff.  That would close his office that has been open for 40-plus years. 

From private offices to hospitals, health care is in for massive change.  Remember Donna and her mother Esther?  Esther is home now.  Their story is at the heart of the most basic ACA claim -- increase the quality of care. 

Only it’s not so clear whether that will happen.

We reviewed several studies from the Massachusetts Medical Society, as that state has a model similar to the ACA.  The most recent study has some interesting facts in it.  In summary, the Massachusetts Medical Society’s 9th Annual Access to Care Study (http://www.massmed.org/News-and-Publications/Research-and-Studies/2013-MMS-Patient-Access-to-Care-Study/#.UmA_IL7nZ-Y) shows that wait times for new patient appointments with primary care physicians remain long and that half or more of primary care practices remain closed to new patients.

Extended interviews and verbatims:

Leann Schaff, Neck Surgery Patient

John Miller, MD - Director Partership Health

Philip Stauffer, Missoula Resident

Kim Mansch, Partership Health, A low or no-income health clinic in Missoula

Carter Beck, MD Montana Neurological Associates

Karen Sullivan, COO Mineral Regional Health Center

John Updike, COO Mineral Regional Health Center

Barry Olsen, The Director of the Rehab Institute of Montana

Steve Carlson, CEO Community Medical Center