By David Nash, M.D., M.B.A.
Medical school dean says upholding of The Affordable Care Act lets us get to the real task at hand: transforming the U.S. health care system.
My initial reaction to the Supreme Court’s ruling to uphold The Affordable Care Act was to breathe a sigh of relief. The law, particularly the individual mandate – the cornerstone provision – is constitutional and now we can get on with the real task at hand of transforming the U.S. health care system into one in which high-quality and safe care is delivered in an effective, timely, and patient-centered manner. To me, that’s the bottom line. And I don’t think the real task at hand would have changed had the Supreme Court struck the law down.
That’s what I kept reminding myself as I awaited the decision in a crowded conference room with many of my colleagues from the Jefferson School of Population Health. Upheld or struck down, the mission would continue.
The air in that conference room was thick with anticipation as the Supreme Court’s ruling began to trickle out. After some initial confusion, it soon became clear. There were not five votes to uphold the ACA on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he 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.
Besides being an obviously big win for President Obama, what the ruling means is that this “health care overhaul,” still only partly in effect, will move forward, picking up momentum as it does so and affecting the way that countless Americans receive and pay for their personal health care.
Personally, I feel this is a monumental decision for the 33 million American who have gone without health care coverage, and the 13 million American non-elderly adults who have been denied insurance specifically because of their medical conditions, according to the Commonwealth Fund. The Kaiser Family Foundation, by the way, says 21% of people who apply for health insurance on their own get turned down, are charged a higher price, or offered a plan that excludes coverage for their pre-existing condition.
The private sector, of course, has already taken significant steps toward changing the way that health care is delivered in this country. Doctors, hospitals and insurers have begun changing the way they do business as they prepare for an influx of new customers and federal incentives aimed at slowing health care spending by rewarding increased coordination among medical providers. I’m happy to say that many are following the medical home model, where care is coordinated and financial savings are shared among doctors, hospitals and other providers.
So, the mission continues. This is a historic time for American health care and now we can continue living up to the challenge of making health care what it can be. Make no mistake about it, massive change in the health care industry is still needed. We need a health care system that puts the quality and safety of patients first, while at the same time reducing cost.
Today I am encouraged by the Supreme Court’s decision and more confident than ever that we will see this through.
David B. Nash, M.D., M.B.A., is the Founding Dean of the Jefferson School of Population Health (JSPH) of Thomas Jefferson University and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy in Philadelphia, PA. Dr. Nash is a board certified internist who is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement.