What does the U.S. Supreme Court’s ruling on the Affordable Care Act mean to Henry Ford Hospital and Henry Ford Health System, and our patients?
The law has been in effect for two years and Henry Ford has been meeting the necessary steps to comply with the provisions of the law affecting us and our patients.
The ruling on Thusday supported the constitutionality of the ACA.
Some of the most controversial aspects of the law are scheduled to be implemented in 2014. Two of these components, mandated insurance and extension of Medicaid, were major subjects of the Court’s ruling.
Mandated insurance was supported as part of the tax provision, that is, failure to adhere to obtaining or providing insurance will be subject to tax penalties.
Without the insurance mandate, the insurance exchanges or pools would likely have fewer healthier enrollees, meaning insurance rates for policies purchased through the exchange would need to be much higher to support costs.
Expansion of Medicaid was left to states wtihout Federal threat of withholding all Medicaid dollars for not extending.
The ruling has brought some “certainty” to the constituionality of the law. This is a certainty that must be looked at through the lens of continued political polarization, the fall elections, threats of repeal of the law in the 2013 Congress, business and personal reaction, and implementation at the state and delivery system level.
But, importantly, this ruling allows Henry Ford to continue to make positive reforms to the country’s health care system, through our efforts to integrate care, reduce costs, increase access and make advances in medical technology, treatment and hospital care.
The ACA means the possibility of extending Medicaid to the nearly 500,000 uninsured people in Michigan, as well as extending additional benefits to lower income familes through insurance exchanges.
The implementation in 2014 also strikes denial of insurance to those patients with pre-exisiting illness. Families will continue to cover their adult children on family policies up to the age of 26.
By expanded coverage for uninsured and low-income patients, the act may help to provide economic relief to Henry Ford’s growing burden of uncompensated care. In the past eight years uncompensated care at Henry Ford has doubled, from $111 million in 2003 to $210 million in 2011.
Having insurance does not ensure access to care or health, and the ACA does not, in and of itself, sufficiently address approaches to reducing help care cost and ensuring affordability for individuals and businesses.
What else is needed?
Expansion of accessible primary care to sites throughout Detroit and our region is needed. Accessible means both location and times of operation to make it easy to provide this care, which, if implemented in our uncompensated population at Henry Ford Hospital, could reduce unnecessary admissions by 25%.
Behavioral (mental health) services need to be accessible as part of primary care extension.
An emphasis on wellness and prevention, including advocacy and implementation of healthy living strategies adopted by patients themselves is critical. This approach needs to help address social issues not normally thought of in health care delivery but are essential to address; issues such as access to nutritional affordable food, safety and lighting, and environmentally safe and toxic free homes and apartments.
— Continue to endorse value-based payment for health providers and hospitals rather than payment for volume will change the orientation of our industry and save overall dollars.
— Adherence to evidence based approaches to what should and should not be done for diagnosis and therapy will also have financial benefit.
— Prudent technology deployment, like our EPIC implementation, will lead to other technologies in the hospital and home to keep patients healthier and out of the clinics and hospital.
I fully understand the political, ideological and financial concerns of the ACA. I share some of these, but I believe the ACA is a step forward in the right direction for our patients and our nation.
It needs some tweaks, and it is my hope that after the fog of rhetoric and the upcoming election, a true bi-partisan approach to making this law work for our citizens, our economy, and our country will emerge.
I had the opportunity to provide sound bites about the Affordable Care Act and Henry Ford through interviews with our local media. The first I call “Doc in the DIV.”
Here are links to my interviews:
— WDIV-Ch. 4 (click here)
— Fox 2 TV Detroit (click here)
— WDET 101.9-FM (click here)