A Better St. Louis. Powered by Journalism.
  • Twitter
  • Facebook
  • Print
  • Email

Health reforms will continue no matter what Supreme Court says about Affordable Care Act

In Health

4:31 pm on Sat, 04.28.12

Though efforts to set up a health insurance exchange in Missouri have failed so far, the concept is regarded nationally as one of the many measures connected to the Affordable Care Act that will take root and thrive no matter what the Supreme Court says about the overall law. The court will soon decide whether Congress went too far in mandating that most people buy health insurance or pay a penalty, and in expanding Medicaid to cover more of the uninsured.

A health insurance exchange is a state regulated health-care plan from which residents can purchase health insurance eligible for federal subsidies. It's part of the Obama administration's efforts to make insurance more affordable to more citizens.

Among those betting on the survival of some form of insurance exchange is Christopher Condeluci, who was tax counsel for the Senate Finance Committee during the period when the health legislation was crafted. He's now an attorney at the law firm Venable LLP in Washington.

"Some of the more liberal states, California and Maryland, are really moving ahead in setting up an exchange mechanism under the new health-care law" he says. "Even if the law goes away, I think they will continue on their current trajectory and set up an exchange under their own auspices."

He also notes that Massachusetts has what amounts to a robust exchange-like system and that four other states -- New York, Utah, Connecticut and Florida -- already have in place bits and pieces of what might be regarded as insurance exchange provisions.

"Those four states will build on the exchange structure they currently have in place," he said in an interview, suggesting that even a dozen or more states might press ahead on exchange programs.

Some states might change their minds if the court scraps ACA, but for now the Kaiser Foundation's State Health Facts website, found that 15 states were in the process of setting up exchanges, three were planning to establish them, and 19 were studying that option. The site says no significant activity on exchanges was taking place in the dozen or so remaining states, including Missouri, which has received more than $21 million for planning and setting up its program.  State Senate leaders have decided to put everything on hold until after the Supreme Court's ruling.

Many benefits will survive

Another ACA benefit that might survive in some form, Condeluci predicts, is the provision allowing young adults to remain on the insurance plans of their parents until age 26. He says Congress would be spurred to save that provision, no matter what happens, because it's popular among voters.

Dave Dillon
Dave Dillon

Many provisions relating to hospital care, cost and quality that predated ACA have been folded into the law and are likely to remain in effect regardless of the outcome of the court decision, says Dave Dillon, vice president of media relations for the Missouri Hospital Association. He says the Affordable Care Act has given added momentum to "what we're already doing." The ongoing focus on quality, he says, "has fundamentally shifted the culture of patient safety and reporting.  It's been ground-breaking in terms of transparency and health-care quality. These types of activities will continue and the scope of reporting will expand."

An example, he says, is  attention to hospital-acquired infections. Nearly two weeks ago, data distributed by the Centers for Disease Control and Prevention showed a 25 percent reduction in the spread of infections to patients at some Missouri hospitals. While the state health department praised the reduction, the CDC noted that the results didn't tell the whole story.

For one thing, only 13 of the state's 156 acute-care hospitals were reporting their data to the CDC. State officials say the rest do report data to the Missouri Health Department. The CDC study for 2010 said Missouri wasn't among the 21 states having the most significant decreases in central line associated bloodstream infections. The federal government has now raised the bar, making it mandatory for more than 70 Missouri hospitals to submit their data to the CDC.  It says the broder sample should give the public a fuller picture of the prevalence of hospital-acquired infections.

Federal health officials also are expected to stay focused on several other patient improvements whatever the Supreme Court decides. These include values-based purchasing under which hospitals are paid based on performance on certain quality measures. They also face a loss of 1 percent of their payments, starting this fall for having to readmit an excessive number of patients because the care wasn't done properly the first time around.

"If you think in terms of 10 years ago, and there was an error in care, if someone had bedsores, for example, Medicare or Medicaid or a private insurer would pay for the condition" which is regarded in federal jargon as "a never event," Dillon says.

Other quality measures include the federal government's website on hospital comparisons, which allows the public to track how well hospitals are performing in relation to one another on several quality measures.

Also expected to remain on track are new quality-care measures that ACA mandates for doctors who treat Medicare patients. Physicians in Missouri, Iowa, Kansas and Nebraska have received a sample report showing that the federal government hopes to impose a "payment modifier" under which doctors would receive higher fees for delivering quality care at a lower cost and less for care that costs more but doesn't improve medical results.

Like many other changes, this one is likely to be reinstated if it's somehow voided by the court decision since the modifier is an attempt to wring some of the needless cost from a health system consuming in excess of $2.5 trillion a year.

Electronic medical records have 'tons of potential'

Dillon notes that the electronic health records program is indirectly part of ACA, though the program was funded by stimulus money. He says the program certainly is expected to survive because it has "tons of potential to change the way health care is delivered." Among other things, the electronic system makes access to medical records easier and quicker, helps to cut out redundant medical tests and to provide more accurate diagnoses and effective treatment.

Beyond the question of what happens if the law is voided, Dillon says, are the issues of how society will care for the uninsured and whether lawmakers would put back the old method of hospital spending. For example, the reform law calls for a $155 billion reduction over 10 years in government payments to hospitals. The assumption under ACA was that health costs would be reduced through improved and better coordinated care, and that more of the uninsured would get help through the Medicaid safety net. It would be expanded to cover individuals earning up to 133 percent of the federal poverty level, which is more than $14,000 in yearly income for an individual.

"If ACA would disappear, there is very little chance that legislators and Congress would put that money back in," Dillon says. "This isn't necessarily about the uninsured but about how health care will be funded. We have to look at a better model of funding. What will happen in the future. That's the big question mark."

1 Comment

Join The Beacon

When you register with the Beacon, you can save your searches as news alerts, rsvp for events, manage your donations and receive news and updates from the Beacon team.

Register Now

Already a Member

Getting around the new site

Take a look at our tutorials to help you get the hang of the new site.

Most Discussed Articles By Beacon Members

Conference of American nuns will mull response to Vatican charges

In Nation

7:55 am on Fri, 08.03.12

Meeting in St. Louis next week, the Leadership Conference of Women Religious will have its first opportunity as an assembled group to consider what to do after the Vatican issued a mandate for change this spring. It calls on the conference to reorganize and more strictly observe church teachings.

The 'free' Zoo

In Commentary

7:51 am on Tue, 05.22.12

When a family of four goes to the St. Louis Zoo, they can be forgiven for not knowing it will cost them $60, $72 if they park. If they can't pay, the alternative is to tell the kids they can't do what kids do at the zoo.

Featured Articles

House sends Boeing incentive bill to Nixon

In Economy

12:55 pm on Fri, 12.06.13

The Missouri House easily passed legislation aimed at attracting production of the 777x, a move that wraps up a legislative special session that saw little suspense and few surprises. The bill now goes to Gov. Jay Nixon, who has strongly supported the legislation.

Gandhi inspired Mandela on South Africa's 'Long Road to Freedom'

In World

10:10 am on Fri, 12.06.13

Nelson Mandela, who died Thursday at the age of 95, was a towering moral figure of the 20th century -- along with Mahatma Gandhi. It was no coincidence that Gandhi and Mandela, whose paths never crossed directly, both embarked on their campaigns against discrimination in South Africa. It was when Mandela won election as South Africa’s first black president that Gandhi's influence became apparent.

Featured Articles

Regina Carter brings jazz and therapy to Children's Hospital

6:36 am on Mon, 12.09.13

One night, the violinist is taking bows before a standing ovation at Jazz at the Bistro. The next afternoon, some of her audience may have trouble standing, but the kids in the playroom at Children's Hospital were no less appreciative. “Jazz is medicine personified," according to a doctor who brings in the jazz musicians.

Encore: Dead before death

In Performing Arts

12:58 am on Fri, 12.06.13

For years , the author was certain he would never come to appreciate The Grateful Dead, let alone be a Deadhead. But little by little, he's come around. He talks about his conversion and relates a real evolution: by a musician who went on to play with the Schwag, a Dead cover band.

Featured Articles

Schlichter honored with St. Louis Award

In Region

4:57 pm on Tue, 12.03.13

The attorney has founded Arch Grants, which brings together nonprofit philanthropy and commercially viable opportunitiesto fund new business startups, and Mentor St. Louis, which finds adult mentors for elementary students in the St. Louis Public School System. He was the driving force behind the state's historic tax credit program.

BioGenerator sets open house to celebrate new digs for entrepreneurs-in-residence

In InnovationSTL

12:29 pm on Tue, 11.12.13

BioSTL's BioGenerator organization is on the move as its entrepreneurs-in-residence find a new home in 4,300 square feet of office and conference space in an old automobile factory. The blossoming program, which helps BioGenerator's portfolio companies to get off the ground, continues to pay dividends within the growing biotech community.

Ambassadors aim to soften rough landing for St. Louis immigrants

In InnovationSTL

6:34 am on Fri, 11.08.13

The St. Louis Mosaic Project is set to hold an orientation for its new ambassadors -- dozens of foreign and native-born volunteers who aim to help make the community a more welcoming place for those from other nations. Participants will be expected to do everything from visiting local restaurants serving international cuisine to having dinner with an immigrant to the area.

Recent Articles

More Articles

Innovation and entrepreneurial activity are on the rise in St. Louis, especially in bioscience, technology and alternative energy. The Beacon's InnovationSTL section focuses on the people who are part of this wave, what they're doing and how this is shaping our future. To many St. Louisans, this wave is not yet visible. InnovationSTL aims to change that. We welcome you to share your knowledge, learn more about this vibrant trend and discuss its impact.

Featured Articles

Regina Carter brings jazz and therapy to Children's Hospital

6:36 am on Mon, 12.09.13

One night, the violinist is taking bows before a standing ovation at Jazz at the Bistro. The next afternoon, some of her audience may have trouble standing, but the kids in the playroom at Children's Hospital were no less appreciative. “Jazz is medicine personified," according to a doctor who brings in the jazz musicians.

Featured Articles

Featured Events:

Upcoming Events

View Full Calendar

More About The Beacon Home