Tuesday, June 26, 2012

What if Health Law is Overturned?

The Supreme Court is likely to rule on the 2010 Accountable Care Act (ACA-Health Insurance Reform-Obamacare) this week and it will be the most important decision this court has undertaken. The court could strike down the entire act or rule that the individual mandate is unconstitutional.  Washington and policy makers are buzzing with possible scenarios depending upon what the court does.  Here are a few of those:

First let's look at Medicare.  The ACA changed the formulas that Medicare uses to pay providers and it will be increasing reimbursement for primary care.  It baked in financial incentives for doctors and hospitals that achieve quality benchmarks.  The Centers for Medicare and Medicaid pays out 100 million medical bills each month according to the new pay scale.  What will happen if the law is overturned?  Will it go back to 2009 pay?  Will pay be frozen until the House Ways and Means and Senate Finance Committees can meet and decide?  No-one knows.

The Health care law also dedicated billions of dollars to expand community health centers and the health care workforce including the Indian Health Service.  If it disappears the legal authority for those programs and funding would also disappear.

Lets look at the Centers for Disease Control and Prevention (CDC).  The law's Public Health and Prevention Fund would lose $10 billion dollars for community health ventures like lead-poisoning prevention and immunization programs.  There are no contingency plans for this funding.

More than 22 million people who would have gotten cheaper health insurance or coverage from Medicare will be out of luck if the law is overturned.   "More than 5.2 million Medicare beneficiaries have saved a total of $3.7 billion on their prescription drugs since the health care reform law went into effect", according to CMS Acting Administrator Marilyn Tavenner.   If the law is overturned, the "donut-hole" will remain open.

Without the federal law, insurers can still deny coverage to people because of their medical conditions and they can exclude pre-existing conditions from coverage.  Take that, Americans, if you have diabetes or arthritis or prior cured cancer.   If you are a young adult covered on your parents policy you might lose that coverage.  In California that has become State law but most States do not cover it.

I have never understood how partisan politics should enter into Health Care. Studies show that most Republicans want the law nullified and have even turned it into a religious issue which absolutely baffles me.  Anti Obamacare spending has outspent supporters 3:1.  But even for people in the health industry the law is confusing and way too complex with provisions that kick in slowly over time.  That has confused everyone.

One thing that is guaranteed.  The Supreme Court ruling will make half of American happy and half of America unhappy.  Attorneys will be employed for the next decade with appeals and further confusion. The Insurance Industry and Pharmaceutical Industry will do just fine in any case because health care will continue to be a growth industry. 


OldSquid said...

The law is complex because those of us that work in healthcare know the “system” is as complex as the human body. To foot the bill for all the good that you mentioned there must be something that people won’t like. That is the individual mandate (IM) more or less. It is called risk pooling. The absurdity of the whole thing is Republicans came up with the IM when countering “Clintoncare” and then in 2009 they are suddenly against it? Additionally most of the people against IM it won’t affect because they have insurance through their employer. So, like slavery abolitionists, they are doing this out of the goodness of their heart? Give me a break. “Leave it up to the states”, the yell. That won’t work because the sick would flock to those states, and the healthy seeing their premiums increase would leave causing the “death spiral” of insurance companies in that state.

Yes the law is flawed; however, what law isn’t. As a physician I work with is fond of saying, “Don’t let great get in the way of great.”

I’ll end with a quote from KevinMD.com’s Trishul Reddy (Chief Resident, Department of Family Medicine, East Tennessee State University):
I would like to emphasize that health is not a Democratic issue or a Republican issue, because it resonates deeply in both parties on many levels. This troubling situation requires action from everyone. It is universal and individual, because we can all relate to it as human beings. Let’s not demonize one party over another and sacrifice our health because we cannot agree. Remember, for the American eagle to soar proud and high, we need both a left wing and a right wing—and they must flap together.

Bruce said...

I am an Independent Insurance Broker selling health and life insurance. Here's how AETNA has responded as a result of the Supreme Court decision regarding the Affordable care Act (ACA):

Supreme Court Upholds Affordable Care Act

Yesterday, the U.S. Supreme Court ruled that the Affordable Care Act (ACA) is constitutional. We will continue to review the ruling, but it is clear the Court's decision to uphold the law does not have an impact on our business strategy or commitment to reforms that make quality care more affordable and accessible. We will continue to fully comply with the requirements of the ACA.

At the same time, we recognize that the ACA did not do enough to address the serious challenges facing our health care system, and we need to fix the problems that remain.

We will continue to keep our focus on compliance with the law. We have dedicated employees and made significant investments to ensure our full compliance with the ACA. We have been, and will continue to be, ready to meet the requirements of the law as we work to address the complex and challenging issues that continue to confront our health care system. We are committed to working with policymakers and other stakeholders to bring about solutions that will make our health care system work better for everyone.

We have an opportunity - if we take a bipartisan approach - to make changes to the financing and delivery of health care so that employers can continue to provide coverage, and Medicare and Medicaid can be made viable long term. As a nation, it is vital that we capitalize on private sector solutions as well as legislative reforms to address the complex and challenging issues that continue to confront our health care system.

I hope this helps some of you understand the ACA a little better.

Anonymous said...

Well I'm in the half that is very glad the Supreme Court upheld this law. You are correct that it is a beginning but an important step for fairness and health care equality. My question is how will costs be controlled and what about the person who still cannot afford health insurance. Will the insurers be offering products that the average guy/gal can really afford?

Toni Brayer, MD said...

Bruce: Thank you for the Aetna response. As a broker you see it from the purchaser point of view. I cannot answer anons question. Can you? Many families without employer sponsored insurance or the single working mom cannot afford even high deductible policies.

Tick Paralysis

 We spotted a Coyote in our backyard, laying near some outdoor lawn chairs.  When we approached she did not jump up and run, as would be...