Healthcare Reform and the Supreme Court

The American Journal of Pharmacy Benefits, May/June 2012, Volume 4, Issue 3

As the Supreme Court nears its decision on the constitutionality of ACA, healthcare reform is already pushing inexorably forward.

As I write this column, the media pundits (and just about anyone with an opinion) are reading the tea leaves, gazing into crystal balls, and studying the tarot cards to predict how the US Supreme Court will rule on the constitutionality of the Affordable Care Act (ACA). Even the National Health Council and 29 leading patient organizations banded together and released a signed statement to show their solidarity for the law.1

While we await the announcement of the Supreme Court decision, we must not lose sight of the fact that a healthcare revolution is already under way in this country, and there is no turning back.

The federal government has already awarded more than $12 billion to states, local governments, employers, community health groups, and healthcare providers to implement various provisions of ACA.2 If the Supreme Court determines the law to be unconstitutional, will state lawmakers repeal their own legislation to create local exchanges? States that are further down the road in implementing ACA reforms will probably keep moving ahead because they see the positive impact these changes will have on their population.

ACA is the most transformative healthcare law since the enactment of Medicaid and Medicare. Under ACA, more people have access to healthcare, such as young people up to age 26 who can now remain on their parents’ healthcare insurance and children under 19 years old with pre-existing conditions. Insurance companies are now prohibited from rescinding coverage over technical mistakes and must eliminate cost sharing for covered preventive care. In addition, the federal government has begun to fix the Medicare prescription drug “donut hole.”3

Then there are the elements that are yet to be implemented under the law, such as doing away with annual limits on insurance coverage, prohibiting exclusions for pre-existing conditions for all people, expanding preventive health services under Medicare and Medicaid, preventing insurance companies from charging women higher rates than men for the same health insurance coverage, and making sure individuals participating in clinical trials do not lose their insurance benefi ts, to name a few.3

One can only imagine the public outcry if these and other important changes to the health system implemented as part of ACA were taken away or kept from implementation. In the spring issue of the journal National Affairs,2 conservative policy analysts wrote that “despite the widespread public antipathy toward the new healthcare law, simply reverting to the pre-Obamacare status quo would be viewed by many Americans, perhaps even most, as unacceptable.”4

Hospitals are already consolidating and working with insurance companies and health providers to change the way care is paid for.5 More and more doctors are becoming salaried employees. Health records are going electronic, and the federal government is getting better at gathering and analyzing health data.6 The creation of Express Scripts Holding Company could alter how and where patients get their prescription drugs in the future if the new entity pushes for more prescriptions to be filled via mail instead of through local pharmacies.7

Much of the debate going forward is certain to focus on mechanisms to address the rising cost of healthcare. It is encouraging to note that some institutions and corporations are already out in front with creative answers.

A few states, such as New Hampshire and Maine, have launched public databases to help people compare the cost of procedures. FAIRHealth.org and commercial sites like NewChoiceHealth.com and HealthcareBlueBook.com also allow patients to do side-by-side comparisons for common procedures and obtain “fair price” estimates.8

Doctors also are trying to identify specifi c ways to improve the healthcare system to better ensure improved health outcomes at lower costs. For example,9 physician specialty organizations, including the American College of Cardiology, unveiled a list of commonly used tests and procedures they say are often unnecessary. Their collective attempt is to help move the healthcare system toward rewarding physicians for better care, not more procedures.9

For certain, the Supreme Court’s ultimate decision will carry major implications for the future of healthcare reform, both nationally and locally. However, no matter what they decide, the momentum is already pushing our country forward toward creating a more effective and comprehensive system that will better meet the needs of patients.

As Delos “Toby” Cosgrove, chief executive of the Cleveland Clinic, recently said, the revolution to improve healthcare delivery is already under way. In his words, “That train has left the station.”6