Publisher's Letter: Let the Games Begin

Edition: September 2012 - Vol 20 Number 09
Article#: 4053
Author: Brian Taylor

Yes, the Olympics are over and we enjoyed many inspiring performances from the world class athletes in London. However, with the title above I was referring to the games that are currently being played by both sides of the healthcare reform debate that we will play out through the election and beyond.

The recent Supreme Court decree regarding the ACA has reverberated loudly across the country. Most agree that the debate isn’t about whether or not we should address the issues of cost and quality, but rather how we go about it. The ACA was such a broad bill with a cobweb of sidebars and subplots that virtually nobody has a full understanding of its size and scope, and its consequences – both intended and unintended.

Consensus says that the ACO movement guided by a coordinated care approach and shared rewards among providers is here to stay. Evidence of this abounds in the number of enrollments in the trial programs being organized and implemented. There is acceptance and buy-in from the major stakeholders that measurable outcomes, resultant from preventive and coordinated care, is a far better way to manage healthcare and ultimately its costs.

But as is often the case, the devil is in the details – and as one might expect in a 2,300 page bill, there are plenty of details. The medical device tax provision kicks off in January. Check out the article on page 52 to see how a number of suppliers are dealing with it.

Not included in the bill, but certainly one of the significant consequences of adding millions of newly insured customers, revolves around the shortage of caregivers. The aging of boomers was already stressing the system, especially in primary care. Faced with continuing reductions in reimbursements, a number of physicians have opted to either retire early or pursue other opportunities. Allied health providers (nurse practitioners and physician assistants) along with other channels like community health centers and retail clinics will also play an important role in handling the increase in traffic.

Some things to watch as these games unfold this fall and beyond will be the states’ reaction to the SCOTUS ruling on the Medicaid portion of the bill. Basically, it was ruled that states have the right to refuse to expand Medicaid coverage without the risk of losing their existing funding which was called for in the original bill. It is estimated that will preclude about 3 million people from access to coverage as a result. But, of course, the biggest question will be what happens in the November election. I doubt that even with a Republican victory, that the ACA will be “repealed” or totally dismantled. There is a chance that it could be reworked to retain the so-called good parts (guaranteed insurability, children up to 26 remaining on parents’ policy, etc.), while perhaps scaling back on some of the unimplemented provisions. It may not be until 2014 before the real financial impact will be seen. For now, those in favor cite numbers showing how much will be saved over the next 10 years and those against will claim the opposite is true.

The smart thing to do is to stay as informed as you can on an issue that impacts all of us personally, but also for those of us in this industry who will be impacted professionally.

Brian Taylor