Well, the Supreme Court has ruled. Good, bad, or ugly, the PPACA is now reality in a big way.
No more guessing, and no more stalling—full speed ahead, or at least ‘til this November. The chest beating is already ramped up on both sides of the political aisle. Democrats are hailing the SCOTUS decision as the best news since WW2 ended, and Republicans are crying foul louder than a flock of Canadian geese. So, now, the next question remaining is what will happen in case of a Mitt Romney presidential victory this fall, and the potential for a Republican majority in both houses of Congress? Let the fireworks begin.
Texas Attorney General Greg Abbott said: “One aspect of the Court's decision that should not get ignored, and that is positive from a constitutional standpoint is that the Court agreed that States are individual sovereigns that cannot be commandeered by the federal government. In this instance, by forcing States to expand Medicaid, the federal government tried to hold States hostage. For this they were rebuked by the Court. But that slim silver lining is little consolation for an otherwise devastating Court decision that hamstrings the free-market, interferes with the doctor-patient relationship and imposes a new and expansive tax—especially on middle-class Americans.”
Political pundit Dick Morris has stated: “The Supreme Court ruled on a narrow issue of whether the individual mandate is legal. But they did not rule on whether the law is a good or a bad one. Most importantly the Court affirmed what I and many critics of Obama have been saying: Obamacare is a tax. It is a tax on every individual to force them to buy health insurance. It is a tax on almost every small business that falls under its onerous strictures. It is a tax on seniors who will see benefits cut by $500 billion—who will now have to pay more out of pocket expenses—and who will be subject to rationing boards known as "death panels." It is a tax on citizens and healthcare providers slapped with new excise fees. It is tax on our most successful income earners—who will now see their capital gains and dividend tax rates be raised by 20 percent.“
Herman Cain stated: “The best that can be said for Chief Justice Roberts, in voting to uphold the law, is that he rejected the administration’s argument that the mandate was permitted by the commerce clause….Mitt Romney has already vowed that he will issue waivers to all 50 states on his first day in office. That is an excellent start. The next step is for the new Congress to repeal ObamaCare in its entirety and replace it with new measures that empower patients and physicians–not bureaucrats and insurance companies.”
Phyllis Schlafly with Eagle Forum said: “The Supreme Court did declare that ObamaCare is a tax…Also, while the Court declared that Congress does have the power to institute a tax to implement ObamaCare, it does not have the power to create such a system under the Interstate Commerce clause. That is incredibly important that the Court declined to further expand Congress’ power under the Interstate Commerce clause.”
According to US Congressman Sam Johnson, the “…Supreme Court ruling on Obamacare is a major setback for freedom and free-enterprise…Americans want, need and deserve better healthcare with a patient-centered approach that allows people to make their own healthcare decisions. Plain and simple, Obamacare puts our health care in the hands of Washington bureaucrats with a one-size-fits-all package filled with tax hikes that our country cannot afford.”
Here are a few alternative suggestions he proposes:
- Allow Americans to purchase insurance across state lines.
- Encourage small business health plans.
- Address tort reform by eliminating junk lawsuits.
- Create universal access programs to guarantee access to affordable care for those with pre-existing conditions.
- Enhance health savings accounts (HSAs).
- Promote healthier lifestyles by creating incentives for employers.
Yet, because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, according to Fierce HealthCare. The exception: a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. The Court limited the federal government's ability to penalize states by withholding Medicaid funds. The provision is constitutional, they ruled, as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.
The folks at McKesson agree that reform is vital for the industry and rest their collective hopes on value-based payment reform as a "very promising" method of change. Value-based reimbursement can lead to medical savings, quality improvement and fewer duplicated services. And, Health Net CEO Jay Gellert said, insurers must do "something profound in the next three to five years," such as containing unit costs and providing better care for special populations. Plus, “one of the many problems with healthcare costs reflect the lack of coordination of care and the duplication of services that result, in part, from the fact that many healthcare providers bear little to no responsibility for efficiency, even now,” said Geisinger Health System President and CEO Glenn Steele.
According to HealthLeaders Media, Catholic Health Partners CEO Michael Connelly suspects a legislative battle will focus on how to modify the health insurance exchange plan to loosen some of the regulations and to accelerate the issue of payment model reform. “Unless payments change, we can't afford costs of expanded coverage. There's universal acceptance that we can't afford the cost of health care. It’s 20 percent of the economy and it is the primary source of the government’s deficit. All know we need to fix the deficit and we can only fix that with Medicare and Medicaid reform.”
And don't count on the commercial market to significantly drive the change to a more accountable and value-based approach to care, at least based on his experience. Connelly also said: "We don't see the commercial market leading this change. The insurance payers actually do better financially in the old model. All their systems are set up to pay fee-for-service, and the vast majority of insurers’ business is still self-insured so they make their margin off of volume. Getting them to move has not been very successful."
Regardless of all the media hype, saber rattling, political posturing, or commentary, health care reform via the PPACA is a definite reality at least for the foreseeable future. No matter what your opinion or political persuasion, the Affordable Care Act-whether affordable or not—is the law of the land. So, as the future fast approaches, consumers and companies need to heed the writing on the legislative wall: Get ready.