Just last week, the U.S. Supreme Court heard arguments on the Patient Protection and Affordable Care Act ("PPACA" or "ACA").

The justices’ focus was on the act’s most controversial aspect: the individual mandate.

For those who oppose this provision, a mandate to purchase health insurance is an intrusion into the lives of private citizens.

For those of us who support it, the mandate is the means to make insurance affordable to all, since coverage would be too expensive if only those who are sick bought in.

The individual mandate is likely to affect only about 5 percent of the population; however, the Affordable Care Act includes numerous provisions that will have wide-ranging effects.

Here are some of the ACA effects:

» Dependent coverage expansion. The ACA gives parents the option of keeping their children covered under their own plans up to age 26. This provision is popular in these times when more young people are having a hard time finding jobs with good benefits.

» Closing the Medicare "donut hole." Seniors were provided a subsidy to pay for medications in 2010 and the gap is eliminated in 2011.

» Improving other Medicare benefits. Since 2010, states have been encouraged to apply for funds to increase coordination of benefits between Medicare, the program for the elderly, and Medicaid, the program for the poor, for seniors who were enrolled in both. Funds are also available to improve community-based options to allow people with Medicare coverage to stay at home instead of going to nursing facilities.

» Preventive services. Under the ACA, insurers have to pay for preventive services for infants, children and adolescents, and for women’s health needs.

» Pre-existing conditions. The ACA established federal coverage options in 2010 for people who would otherwise be unable to get insurance due to ongoing costly health conditions.

» Primary care incentives. We have long been underpaying primary care physicians. This has resulted in a national shortage of family practitioners, geriatricians and others who need to be the foundation for our health care system. Under the ACA, Medicare and Medicaid will be increasing payments to primary care providers.

» Hospital readmissions. The ACA incentivizes hospitals to reduce hospital-acquired infections and turn-around admissions for preventable conditions via Medicare and Medicaid payment policies.

» Additional funding options. The Affordable Care Act encourages states and providers to demonstrate the effectiveness of innovations that improve care and reduce costs, such as patient-centered medical homes.

» Benefits for the most vulnerable. There is a high correlation between poverty and poor health. This is tragic and costly, since a large proportion of people who are uninsured are low-income adults too young to qualify for Medicare.

Medicaid programs were established to ensure care for people living in poverty, but states vary significantly on eligibility qualifications. The ACA will set eligibility to Medicaid for adults at 133 percent of the official poverty level. The federal government will pay for a "basic health plan" to cover adults up to 200 percent of poverty as a state option.

Inspired by the federal act, there’s a lot that states can do to transform health care, and Hawaii is one of the forward-looking places that will be moving ahead with innovation and improvement.

It would be a real disservice to all Americans, though, if the Patient Protection and Affordable Care Act were struck down in part or in whole when we need the good medicine it offers as a cure for our ailing health care system.