What will the big stories be for the Affordable Care Act (ACA) in 2012? Access, affordability and quality win the day. The ACA year opens with a scintillating GOP primary and election year intrigue; and the Supreme Court hears arguments on the “individual responsibility” requirement and the constitutionality of the Act.
Through the year, sweeping Medicare quality and cost reduction projects roll out focused on financial rewards to health care providers for keeping patients healthier, reducing hospital reimbursement for avoidable readmissions, helping seniors receive care in their homes, cracking down further on waste, fraud and abuse, and continuing to close the donut hole gap in medication coverage.
Pharmaceutical companies start coughing up some money for branded products purchased outside of the country; and insurers start funding comparative effectiveness research aimed at answering questions about which treatments are most effective.
The states continue to ready themselves for the health exchanges due to go live in 2014. And a diversity database is established with the goal to reduce the gap in getting good health care for minority groups. All tolled, 2012 is focused on continuing to improve access, quality and affordability.
Here’s a look at the top stories.
1. The Supreme Court ruling – More than 100 law professors, 35 economists, and three Nobel Prize winners say there’s no doubt the new health law is constitutional. A majority of bipartisan circuit court judges have ruled in favor of the law’s “individual responsibility” requirement where everyone must have health insurance. This is an essential element of the Act, without which its goals to improve access, affordability and quality, could not endure.
2. The battle for the White House – The GOP candidates want to eviscerate the Act, but even if one of them were to prevail in the general election, it would take overwhelming agreement with a majority House Vote, White House support and 67 votes in the Senate, to abolish a law already on the books. Don’t expect the 2012 election to be an upset for the Affordable Care Act. The likely GOP nominee, Mitt Romney, also advocated for an individual responsibility requirement previously and passed similar health care legislation in Massachusetts. Reversing bans on lifetime limits, discrimination against those with preexisting conditions, reduced medication costs, free preventative care, and better quality, already in effect for millions of Americans will not be popular, or easy. Americans know that the quality of their lives depends on the quality of their health and they won’t be keen on losing it.
3. Oh, Florida! – Not much good news from the nation’s most unpopular governor, Rick Scott. Scott’s extreme response in Florida to block the reforms and the federal money provided for health care access are a big political risk. Florida isn’t accepting federal monies to ready itself for the exchanges, isn’t working on accountable care projects, isn’t working to expand benefits through Medicaid, and is spending its resources in delay and legal actions against the government in order to preserve industry profit at citizen expense. The consequence: Florida isn’t ready; its citizens aren’t covered; its healthcare future is in limbo. The federal government is poised to step in to set up the insurance exchange for its residents and has refused its request to allow Medicaid vendors to spend less money on health care. What other assaults will the governor cook up this year? Stay tuned.
4. Better Access, Affordability and Quality – Watch the numbers and follow the money! Hard trackers will report the numbers of private sector health care jobs created, people insured, protected and using preventive, acute and chronic services under the ACA. Goodbye lifetime limits and discrimination against those who with preexisting conditions! Expect more savings through quality and less tolerance for fraud, waste and abuse. Thirty-two health provider organizations will roll out innovative care delivery programs (accountable care organizations), for Medicare enrollees with payment based on quality of care outcomes. This year some seniors will get access to service in their home, and get rebates for medications when they fall in to the donut hole. And the pharma and insurance industries starts foot some of the bill for research to find treatments that work, while getting capped on profit at the expense of quality. Expect reports on the cost of premiums for states, employers, and individuals as the Health Care Exchanges rev up; what its like for people who need and use care, health care professionals who provide care, and hospitals and systems that support care; and payment based on effectiveness of care and patient oriented outcomes that matter, rather than on the volume of procedures and visits.
Rome wasn’t built in a day, and neither will be the ACA. This is a big law with a big agenda for a great nation. Already, it is improving access; improving quality through reduced waste fraud and abuse, paying for performance; better medical evidence and innovation; making health care overage and care more affordable; making big pharmacy and insurers pay their fair share; and driving the creation of health care sector jobs. These initiatives that will continue to return benefits for years to come. The individual responsibility requirement, up for a challenge in the Supreme Court this year, and health exchanges are critical to solving the affordability puzzle.
The ACA solves big problems with innovative and entrepreneurial solutions. There’s nothing more American than rolling up our sleeves and using our ingenuity to meet the important challenge of fixing our health care system.