The Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) also known as ‘Obamacare’ this week. While the legal scholars continue to ponder the implications of the case, it appears the Supreme Court shied away from making any decisions about the virtues of the law. Instead, they confirmed that Congress has the ability to pass legislation requiring individuals to purchase health insurance, and if not, to be subject to a tax.
In essence the Court stayed out of the legislative arena and returned the debate about the actual merits of the legislation to Congress. Indeed the House of Representatives has already scheduled hearings to repeal the ACA later next month.
Regardless of how one views the merits of the ACA, this is clearly a landmark occasion as it relates to healthcare in this country, similar to the passages of Medicare and Medicaid in the 1960’s. At that time, the American Medical Association was a strong opponent of the passage of those 2 social programs, for many of the same arguments being expressed today about the ACA, which seeks to ensure healthcare coverage for Americans who are not covered by those two programs. Despite the opposition from organized medicine in the 1960’s, Medicare and Medicaid have provided health security for millions of poor and elderly Americans and ironically, the majority of the AMA members who opposed this legislation subsequently saw their incomes double over the years following the implementation of those programs. And many have used Medicare for their own healthcare!
Given the commercialization of healthcare delivery in this country, we will continue to have debates on how best to ensure that all have access to high quality affordable care. The ‘individual mandate’ to have health insurance stands (at least for now) and remains a crucial piece of the ACA. In fact, this is the reason why the health insurance industry agreed to go along with the ACA. They understood that the costs for providing care for all needed to be shared among a large pool of individuals, including the healthy, who were not inclined to purchase coverage. If only the sickest individuals had health insurance the cost of coverage would skyrocket and become even more unaffordable for millions of Americans.
Much of the ACA was based on legislation which had been developed in Massachusetts and I have been living under ‘universal healthcare’ in Massachusetts for several years now. I’ve been seeing more middle-aged adults coming in to my office for chronic diseases, who previously avoided care because they did not have health insurance. A downside of this legislation may be that healthcare costs rise in the short term. Currently the Massachusetts governor and legislature are aggressively looking at ways to decrease healthcare costs. These efforts will likely result in decreased provider payments, especially for specialty care, while trying to preserve and expand the primary care base.
Our challenge is to be active participants in the battle to control costs to ensure that health care is affordable for all. One way you can assist in this area is by following the ‘Choosing Wisely’ campaign, which has been endorsed by many of our specialty societies. We have blogged about specific aspects of the Choosing Wisely campaign to help you understand how best to save healthcare dollars by appropriately ordering diagnostic tests and evidence based therapies. We will continue to provide that information over the next few months, so regardless of where you stand on the politics of the ACA, I encourage all of you to get on board with the Choosing Wisely campaign to help ensure that health care is affordable for all of our patients, regardless of how it is paid.
-Robert A. Baldor, MD