For the nation’s health care system, there may be no going back on health care reform, even if the PPACA is ruled by the Supreme Court to be unconstitutional next June.
The PPACA passed into law n March 22, 2010 over two years before the Supreme Court will rule on its future as either landmark health care legislation or a legislative failure of the first rder by the Obama administration.
But two years of policy making and implemetation mean that no matter what happens much of the PPACA might remain in effect even if the law is struck down. If it is struck down its a foregone conclusion that the individual health insurance purchase mandate wilol be the first card to fall.
However, the health insurance exchanges may still remain in effect in many states as the IT costs and infrastructure building may be too costly to dismantle and put on the scrap heap. That's especially true for Governors who believbe in the PPACA and the exchanges. Afterall, the exchanges are state-based so some, if not many could remain in effect.
No matter what the Supreme Court decides about the constitutionality of the federal law adopted last year, health care in America has changed in ways that will not be easily undone. Provisions already put in place, like tougher oversight of health insurers, the expansion of coverage to one million young adults and more protections for workers with pre-existing conditions are already well cemented and popular. Trying to undo those would be quite unpopular.
Increased Focus on Costs
And a combination of the law and economic pressures has forced major institutions to take a hard look at costs. From Colorado to Maryland, hospitals are scrambling to buy more hospitals. Doctors are leaving small private practices. Large insurance companies are becoming more dominant as smaller ones disappear because they cannot stay competitive. States are simplifying decades of Medicaid rules and planning new ways for poor and rich alike to buy policies more easily. In short, the landscape has already shifted in major ways.
But how to pay for these changes, and what will happen to the 30 million uninsured Americans the law intends to cover, will be up in the air if the mandate at the heart of the law — the requirement that individuals buy health insurance or face a penalty — is struck down.
The election results of 2010 and stiff state opposition to the mandate also complicate the picture. Hospital administrators, insurers and doctors are counting on federal subsidies and coverage expansion that would result in a surge of patients with insurance to offset cuts in government programs that many fear could soon become draconian. Large health systems could then use their newfound clout to demand higher prices from private insurers even as federal and state governments pay less.
Specific Impacts
“If the law is struck down, health care reform will have to continue one way or another,” said Patricia Brown, president of Johns Hopkins HealthCare. Across town, Baltimore Medical System, a community health center, expects to expand its medical staff by 50 percent over the next three years to accommodate an anticipated increase in patients to 70,000 from 47,000.
In states like Texas (which has the highes reat of uninsuredresidents), the law is deeply unpopular, and the medical association has a “Calendar of Doom” listing the timeline for important provisions of the law and other government rules. Still, changes in delivering medical care are taking hold, including a move away from small doctor practices that were predominant for more than a century.
Lasting Effect
And even though critics say the law does little to reduce the costs of care, its passage touched off myriad efforts to pare widespread waste. “The interest from the doctor and hospital community has accelerated,” Tom Richards, a senior executive at Cigna, said of efforts to exact savings and improve care.
If that's the lasting effect, than even in failure if ruled unconstitutional, the PPACA may have a lasting positive effect.
