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Top 3 Recent Outcomes of the Affordable Care Act in 2015

"There has been some question to date because of the failure of Pioneer ACOs and the regular MSSP ACOs to show much cost savings but what folks have overlooked is that the ACO movement has been an organizing force throughout the healthcare industry."

- The Obama administration’s Patient Protection and Affordable Care Act has dealt with a multitude of opposition since its passage and this past year has been no different. There are still partisan politics at play when it comes to the healthcare law’s impact on the health insurance field and spreading coverage to the uninsured. Below we outline some of the most recent goings-on with the Affordable Care Act.

Budget Reconciliation Bill

Senate passage of a bill to repeal Obamacare

In early December, the US Senate passed the budget reconciliation bill in a 52 to 47 vote, which guts a number of important provisions within the Affordable Care Act. This is the first time such a bill could be sent to the President’s desk, but it is fully expected that President Barack Obama will veto the legislation.

Majority Leader Mitch McConnell (R-Ky.) originally introduced the bill on the Senate floor. The House of Representatives must also move forward with passing the bill, but it is unlikely to lead to any repeal of the healthcare law due to an expected veto by President Obama.

“Six years ago, Republicans warned the president about the disastrous consequences of Obamacare for millions of Americans,” Senator Lamar Alexander (R-Tenn.) said in a public statement. “Unfortunately for these Americans, Republicans were right when we said that Obamacare would burden state Medicaid budgets, increase premiums and taxes, and hurt jobs. We need to start over and go step by step toward the goal of reducing health care costs.”

“I renew our invitation to the president, and if he doesn’t accept our invitation, I extend it to our next president: Forget about party, forget about this side or that side, and side with the American people whose premiums went up, who lost plans they liked, whose Medicare has been raided, whose state budgets have been destroyed, and whose jobs have been lost. Work with Republicans in Congress to fix the damage Obamacare has done to health care in America. Work with us to replace Obamacare with real reforms that lower costs so more Americans can afford to buy insurance.”

Some of the biggest provisions that this bill is looking to repeal include the federal government’s involvement in health insurance exchanges and subsidies offered to those unable to afford health plans through the exchanges. Another major issue that the legislation is looking to put a stop to is the Medicaid expansion taken by 30 states, which could potentially harm those newly covered under the Medicaid program.

“This appalling legislation guts the ACA, the greatest advance for women’s health in a generation,” Debra L. Ness, President of National Partnership for Women & Families, wrote in a public statement. “While we are grateful that President Obama will veto this legislation, its passage in both chambers is a painful reminder that Congress is badly out of touch with the country and unwilling to legislate in the best interests of women and families.” 

Employer insurance mandate and its Constitutionality

Earlier this month, the Association of American Physicians and Surgeons (AAPS) asked the Supreme Court justices to produce a writ of certiorari in a case that challenges whether the employer insurance mandate within the Affordable Care Act is constitutional.

The case is called Stephen F. Hotze, M.D., and Braidwood Management v. Sylvia Mathews Burwell and Jacob J. Lew and looks to determine whether the employer mandate moves beyond the Origination Clause of the Constitution.

The employer mandate is a provision requiring employers with more than 50 employees who do not provide affordable healthcare coverage through their business to receive a penalty tax when at least one full-time employee has purchased health insurance through the exchanges and receives a subsidy.

AAPS Executive Director Jane Orient, M.D., spoke with HealthPayerIntelligence.com and offered her opinion on the Constitutionality of the employer mandate and the Affordable Care Act.

“We filed a lawsuit against ACA three days after it was signed into law, arguing that it was unconstitutional on many grounds,” Orient explained.

“It violated the commerce clause. The federal government has no authority to intrude into the health insurance market. It should be overturned in its entirety. Later, we filed a case against it after the Supreme Court determined that the penalty was a tax. [We filed because] it was unconstitutional since it violates the Origination Clause of the Constitution which says that all revenue-raising bills have to originate in the House of Representatives.”

Orient and the AAPS also support the budget reconciliation bill and a full repeal of the Affordable Care Act due to the unconstitutionality of the employer insurance mandate as well as the individual mandate requiring Americans to purchase health insurance or receive a penalty tax.

“I think it’s good that parts of the Affordable Care Act would be repealed. I think the whole thing fits together on one part and depends on the other part,” Orient mentioned her views on the Budget Reconciliation bill.

“A part repeal is going to destabilize what was already a clunky, unstable, highly expensive, crony capitalist bill. We’re in favor repealing each and every part of it.”

ACA’s Accountable Care Organizations show promising results

While there have been some concerns about whether Accountable Care Organizations, established under the provisions of the Affordable Care Act, will successfully reduce healthcare costs, CMS reports some positive findings from the last few years.

For instance, Pioneer ACOs and those participating in the Medicare Shared Savings Program generated a total of $411 million in savings in 2014. The results illustrated that ACOs that have been around for longer and have more experience tend to outperform those newly established.

Last year, Pioneer ACOs brought in $120 million in savings, which is a jump from the $96 million of savings from 2013. Under the Medicare Shared Savings Program, 37 percent of ACOs that began the program in 2012 garnered shared savings while only 19 percent of those that became established in 2014 were able to reach quality benchmarks and cost-cutting goals.

Ted Schwab, ‎Managing Director at Huron Healthcare, spoke with HealthPayerIntelligence.com in November about the promise of Accountable Care Organizations.

“I think that there has been some question to date because of the failure of Pioneer ACOs and the regular MSSP ACOs to show much cost savings but what folks have overlooked is that the ACO movement has been an organizing force throughout the healthcare industry and it’s got hospitals and doctors for once under the same umbrella talking about efficiencies, clinical protocols, and ways to save costs,” Schwab described the potential of the ACO model.

“There are now north of 700 of these organizations in the United States of America. If you think about where the industry has been for the last 100 years, it’s been a mom-and-pop fragmented industry. Now you have 700 organizations with folks at least talking to each other. It’s going to take a while.”

“We’re at the very beginning of this movement and I could not be any more encouraged.”

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