I used to consider myself an eternal optimist. Until, that is, I fell prey to reading the onslaught of opinions about how little the Supreme Court’s imminent ruling on the ACA means to health reform in America.
Would the Supreme Court overturning the Affordable Care Act steal the wind from health reform’s sails – or will America continue racing forward to better care for patients and populations at a lower cost even without the legislation?
To read many of the articles in these days leading up to the Supreme Court’s ruling on the Affordable Care Act, the fate of health reform in America is only loosely-tied to the law and its accompanying tens of billions of funding dollars.
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And there’s some evidence that such thinking may be applicable to the accountable care model. A report from the Health Intelligence Network determined that the ACO model has gained momentum in the last year such that ACOs will likely continue regardless of the ACA’s fate.
I’ll throw the proverbial caution to the wind here and suggest that Supreme Court justices already know this much about fate: There’s no pleasing everybody with the imminent ruling. This week Pew backed that up the old-fashioned way – with data.
“The public’s expected reactions track along partisan lines,” Pew wrote in its report. “Most Democrats would be happy if the law is upheld, while most Republicans would be happy if it is thrown out.”
More specifically, nothing short of ruling the entire law unconstitutional will make 40 percent of Republicans happy, Pew found, while spiking either the entire law or the individual mandate would be enough to placate 29 percent.
Not that Democrats are less discerning. On the left, 39 percent responded that keeping the entire law would make them happy, while 17 percent would be pleased with either the whole ACA or everything but the individual mandate.
What’s considerably more difficult to gauge is how much citizens, anyone really, actually understand the differences between Romneycare and Obamacare. Hence, the mashup Obamaneycare. But are the plans a Trotskyite takeover or a big company bail-out? At least one socialist party leader, ironically enough, believes the latter.
Out on the campaign trail, while Mitt Romney and the GOP are outlining the health reform facets they like even if SCOTUS kills the bill, HHS and ONC officials held a town hall at the White House to tout EHR success stories.
That’s great, but here’s a question: Since the EHR and meaningful use program funding comes from the HITECH Act within ARRA, it’s protected from the Supreme Court for now, but what of the federal funding for ACOs, health information exchanges, health insurance exchanges? Incentivizing the healthcare industry toward widespread EHR use enables these higher-level pieces of health reform, folks, and they are critical not only to one day achieving the triple-aim but, in the near-term, to keeping the health reform winds blowing.
There’s no momentum-maintainer quite like the almighty dollar.
Without Medicaid Shared Savings, ACOs lose a chunk of incentive cash for operating as ACOs – not that there aren’t other benefits and incentives. HIEs and HIXs, meanwhile, already face incredible uncertainty regarding their future financial sustainability. Yes, the plan has been for government funding to get these exchanges off the ground so they could stand on their own – well what happens if many of them don’t get their sails rigged to catch a revenue stream before the funding ceases?
[Political Malpractice: What SCOTUS ruling might mean to Vermont's single-payer plan.]
Sans the ACA, private industry will continue to drive innovations, HITECH will keep funding EHR adoption and meaningful use, like many other industries healthcare will harness new and exciting technologies to better the business and, I hope, improve patient care. And there will be big insurance payers that hang onto some reform measures already in place, those being coverage for dependents up to age 26, restrictions on lifetime limits, and preventative services.
Any notion that nothing will be lost if SCOTUS kills ACA, that health reform momentum will continue, pardon the mismatched metaphor, full steam ahead, that ACOs, HIEs, and HIXs won’t find themselves financially in irons, is just overly-optimistic, to put it mildly.
The funny thing is that I’m squarely in the boat of those thinking that Obamacare is an imperfect bill, a start and not a terribly good one that’s been misdirected by politics more than intent – but a horizon to sail toward, with plenty of sail-trimming and navigating-by-stars expected along the way.
For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.
