As a student of medical anthropology living and studying in the Middle East, two areas of U.S. politics are particularly relevant to me: healthcare and foreign policy.

Despite the occasional statement from Governor Romney revealing a bit of confusion on the politics and geography of the Middle East, as well as the lament from contacts on social networks that “somewhere in the Middle East a radical Muslim is celebrating” due to Obama’s victory, foreign policy was not a true dividing line between the candidates this year. In fact, I would imagine most “radical Muslims” are more angry about drone attacks–which have increased exponentially (in Pakistan and Yemen especially) during Obama’s first term, support for Israel, and sanctions against Iran–than they are celebrating his election. Most of my Iranian contacts and Syrian friends (here in Turkey so they can continue their education despite the war) are at best indifferent towards Obama (and in my mind they are all pretty far from the “radical Muslim” label). As Ian Bremmer (political science, Colombia) wrote on Reuters this week, “rocking the vote may not rock the boat.” What he means is that given the rather slight nature of the differences between the candidates’ foreign policy approaches and the overwhelming emphasis given to domestic issues and trouble at home, any election result was unlikely to have a drastic impact on the momentum of world events.

But while it may be business as usual for U.S. foreign affairs (especially in the Middle East), there is an issue whose trajectory has been decisively set by Obama’s victory–healthcare. Obamacare, or the Patient Protection and Affordable Care Act, was signed into law in 2010 and with Obama as president is no longer in danger of being repealed. This in and of itself demands attention–though there will be reforms and changes, the basis of this American version of universal healthcare is likely here to stay. Regardless of your level of disappointment, joy, or indifference after last night’s result, Obamacare may be the most tangible change we see that is directly attributable to the presidential election. And regardless of your views on Obamacare–on the individual mandate, on the provision requirement for companies with greater than 50 employees, on extending Medicare to everyone under 133% of the poverty line, or on subsidies for purchasing private insurance for those from 133 to 400% of the poverty line–there are two little-discussed and closely related sections of the law that provide great opportunity for improving healthcare delivery in the United States.

These are sections 3025 and 3026. Never heard of ‘em? I’m not surprised, most people–especially including those staunchly opposed to or highly in favor of Obamacare–don’t seem to actually know that much about the law. Those on the more informed side usually only focus on the big ticket items, like those listed above. Sections 3025/3026 are relatively limited in scope and are not perfect–I am not going to argue that they will improve healthcare delivery, only that, depending on implementation and eventual scope, they have the potential to do so.

Section 3025 is written with the goal of reducing hospital readmissions (basically, return of a patient soon after discharge for the same or related condition) and their associated costs. These costs are substantial, to put it lightly. Within the Medicare system alone, readmission amounts to an additional (read: unecessary) cost of $17.5 billion annually. A 2004 study in Medical Care Research and Review, based on 1999 data from New York, Pennsylvania, Tennessee, and Wisconsin, found an additional cost of $730 million for readmission for preventable conditions over (only) a 6 month period for a study population of (just) 425,344 persons discharged from hospitals in January-June 1999. Nationally, the Institute for Healthcare Improvement puts the figure at $25 billion in preventable additional costs per year.

Section 3025 requires the Centers for Medicare and Medicaid Services (CMS) to reduce payments to hospitals with excess readmissions. Currently, this applies to excess readmissions for heart attack (AMI), heart failure, and pneumonia. This in and of itself is not necessarily a good thing, as KHN points out it will be hospitals treating the poor that are the hardest hit. However, the potential lies in the methods that section 3025 and 3026 lay out for achieving reduction in readmissions. Section 3025 requires that the department of Health and Human Services provide quality improvement programs through Patient Safety Organizations or PSOs. Closely related to this, section 3026–the Community-Based Care Transitions Program (CCTP) provides funding and support for organizations working at the community level to improve transition from inpatient to ambulatory care and reduce readmissions.

We have in sections 3025 and 3026, then, a federal incentive for hospitals to reduce readmission and a federally-supported program for community-based care. Looking at some of the partners for the CCTP that have been announced shows the potential of this model. The Atlanta CCTP, for instance, states that their intervention is “two-pronged” and uses both the Coleman coaching model (patient coaching) and a need-based “short term supportive service package” that consists of free home delivered meals, two round trip transportation trips to medical appointments, and in-home services provided for 2 hours per day for up to 3 days.

This kind of care has long been advocated by professionals that have worked in successful medical programs in less privileged areas of the world, and returned home to find an expensive and cumbersome system that still doesn’t deliver better outcomes. One of the primary strategies that has allowed organizations like Partners In Health–a darling of the applied anthropology world–to be so successful treating difficult diseases in places like Haiti and Rwanda is their reliance on community health workers, accompaniment, and supplemental aid for families and patients undergoing treatment (e.g. food, transportation). If the programs supported by sections 3025 and 3026 of the Affordable Care Act (PSO and CCTP, respectively) continue to lean in the direction of a community-based model that includes accompaniment and supplemental aid, we are likely to see reductions in readmission for the three key maladies currently identified by the Department of Health and Human Services (heart attack, heart failure, pneumonia). Not only does this model provide patients with better and more dignified care (rather than automatically blaming treatment failures on “noncompliance” across the board), it will also save the healthcare system a great deal of money.

Section 3025 of the Affordable Care Act provides the incentive to adopting these programs in over 2000 hospitals. If the implementation arms of sections 3025 and 3026, Patient Safety Organizations and the Community-Based Care Transitions Program, prove successful for these hospitals, there is good reason to think similar programs (community-based accompaniment with supplemental aid) will be implemented in other hospitals looking to improve outcomes and reduce costs associated with returning patients. We can also hope that demonstration of this model’s effectiveness on a broader scale will lead to its adoption for a variety diseases–not just the three expensive maladies identified here.

Those of us familiar with the effectiveness of the community-based model of health care should watch the roll-out of Obamacare closely, particularly sections 3025 and 3026. There has never been more federal support for a community-based model of care (through the PSOs and especially the CCTP), nor more of an incentive for such a program to be adopted at so many hospitals across the country. Success is not guaranteed. If Community-Based Care Transitions Program partners are not welcomed by hospitals, are not able to reduce readmissions, or are not support by the Department of Health and Human Services at the needed level, the act may indeed end up doing nothing more than punishing hospitals that have a higher population of poor patients. But if these programs are successful in reducing readmissions (and thus costs), we may for the first time begin to see truly nationwide momentum towards implementing community-based healthcare with accompaniment and supplemental aid for patients. That would be a very good thing.