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Sunday, 29 November -0001 19:03

An Unhealthy Uncertainty

By | News

SARATOGA COUNTY – This week the Supreme Court heard arguments on the constitutionality of the Affordable Care Act (ACA), and will take into account whether or not all, part or none of the law will stand. While Americans will likely have to wait until at least the summer before the verdict is made public, many health care organizations and hospitals are left wondering how to plan for an uncertain future. For many local hospitals the question remains: how do you prepare for a system where all of the ACA remains intact, where only parts of the ACA remains, or where the ACA is struck down entirely?

For Jim Connolly, president and CEO of Ellis Hospital, there remain many questions about the ACA if it were to stand as is, especially regarding insurance exchanges set up by the law. Such exchanges are state-regulated health plans from which individuals can purchase their insurance. However, “There are a lot of questions on how these insurance exchanges will work,” said Connolly.

“We have no information on it. We don’t know what kind of products are going to be in there, we don’t know what the deductibles are going to look like and we don’t know what the insurance is going to look like.”

As it now stands, Connolly worries that the ACA falls short in several areas.

“My concern is this act was passed really with the intent of doing two things: expanding coverage and reducing the cost of health care. And I don’t think it’s doing anything to reduce the cost of health care.”

Indeed, health care costs continue to climb, and many worry that the ACA does little to stop the spending curve. Still, there is little doubt that coverage has been expanded by the ACA. Under the ACA, there is no longer a maximum amount in terms of coverage limits on health care insurance; children cannot be denied health care insurance based on pre-existing conditions; and a greater number of patients should have access to health care through the insurance exchanges and the individual mandate.

That is, if the individual mandate is not thrown out by the courts.

When the ACA was initially designed, reimbursements from Medicare and Medicaid were cut significantly. The individual mandates were designed in part to help close that gap, but what happens if the individual mandate is ruled unconstitutional?

“If the individual mandates go away but those cuts stay in place, you’ve essentially got the worst of both worlds,” said Brad Sexauer, vice president for strategy and marketing development at Saratoga Hospital. “If you don’t require everyone to buy insurance but you’ve taken away some of the potential reimbursements moving forward, you’re almost worse off than when you started.”

Another question that arises if the individual mandate were to be cut: “If the Supreme Court strikes down the individual mandate, will they also strike down the part of the law where companies have to offer [insurance plans] as well? We don’t know,” said Connolly.

Of course, the Supreme Court could decide to do away with the ACA entirely, and declare the whole law unconstitutional.

“The largest problem if the law were to be struck down entirely is that we still have a lot of uninsured people in the country, and then there’s no way to bring any more of those people into the system,” said Sexauer. “It means more people will continue to use the emergency room as their primary source of health care, and then private insurance companies will have to pay more than their fair share to help pay for some of those costs.”

This cost-shifting is reflected in the amount paid by those who already hold insurance, private individuals whose health care costs increase to essentially pay for the uninsured.
The ACA was designed to tackle a health care system whose costs were skyrocketing. If the law were struck down, all of those problems would still exist, leaving America and its health care system back at square one.

While hospitals such as Ellis and Saratoga are steadfast in their belief that they will still be able to deliver quality care to local patients, Connolly worries that regardless of the Supreme Court’s decision, the future of health care looks troubling.

“In fact,” said Connolly, “depending on your perspective on this law, it’s not so unpredictable. The future is bleak. It’s just a question of how bleak, not whether it’s going to be bleak or not.”

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