EMHS

EMHS Reaction to Supreme Court Decision on the Patient Protection and Affordable Care Act

6/28/2012
 
 Today, the Supreme Court of the United States handed down its long-awaited decision on the Patient Protection and Affordable Care Act – aka healthcare reform, or “Obamacare.” 
 
The Decision in  Brief:
The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, was upheld as constitutional. There were not five votes to uphold the premise that Congress could use its power to regulate commerce between the states and require everyone to buy health insurance. However, five justices agreed that the penalty (imposed when someone refuses to buy insurance) is a kind of tax that congress can impose using its taxing power. That is all that matters. Because the mandate survives, the court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.
 
What does this means for health reform and the future of healthcare delivery?
  • A quickened pace to models of delivery and reimbursement
  • More accountable care and other types of care delivery organizations
  • A continued focus on primary care and chronic disease management
  • New arrangements with insurers and providers.
  • Continued financial pressure on providers  - physicians and hospitals
 
What it Means for EMHS
To help you understand what affect today’s Supreme Court decision could have on EMHS’ reinvented initiatives, as well as the other great work going on across our system, we prepared a Q&A document that we hope you will find helpful.
  • How does this … or does this affect EMHS?
    • We will continue our reinvention of healthcare delivery, moving toward a population health – value based model. We are moving from today’s model of getting paid for the amount of tests we order and procedures we do, to one of “value,” which means we get paid for keeping people healthy and, when necessary, managing their healthcare needs. EMHS will monitor reimbursement changes with anticipated Medicare cuts and the influx of newly insured patients over time as the changes take place.
  • Are we pleased with the decision? Will our work focus change?
    • While the Affordable Care Act is far from perfect, the need to change the current healthcare system is inarguable. We anticipate multiple bills, probably from both parties, to refine it and improve it, but the nationwide momentum to reform healthcare will likely increase.
    • Our work does not change. We will continue with the work that is more than two years underway. EMHS’ effort to move to a value based, population health model was not dependent on the Affordable Care Act. The fact that the ACA has remained intact may spur on more pilot projects such as the Pioneer Medicare program, in which EMHS is one of 32 organizations participating. 
  • What would you say to those people who wanted the court to strike it all down?
    • We encourage opponents to join in productive, bipartisan discussion about how to improve healthcare delivery and how to design insurance and care delivery models that are affordable. We believe the Pioneer Accountable Care program will be one such early success.
  • This is an election year and health reform is a hotly debated topic. What do you think whoever is President and the next Congress need to do in the next four years?
    • We will continue to advocate – through the Maine Hospital Association, as well as directly with state and national policy makers and legislators – for a more connected and coordinated care delivery model. We want to see the success of care coordination serve as the basis for healthcare spending that incentivizes efficiency and quality outcomes. The need for change is too great to ever think about turning back to a model that simply no longer works.
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