The Supreme Court has spoken: Now what?

Like many of you, I was in a meeting Thursday morning when one of the smart phones pinged with news of the Supreme Court’s ruling on the Affordable Care Act. And, I would imagine, like many of you, we stopped what we were doing to talk about it. No surprise there since this has been on the minds of all of us in healthcare and of many, if not most, of our fellow Americans. After all, no less perhaps than the future makeup of U.S. healthcare was at stake.

So, now that there is a decision, what does it mean? Well, regardless of political leanings or personal opinions, there are two main points of consensus, in my opinion:

#1 – At some basic level, there is some intrinsic value in a decision irrespective of the content of such decision. There is now at least a partially known landscape and with this relative clarity, we can leave behind any stasis stemming from uncertainty and move forward with steadier steps.

#2 – To some degree, the outcome didn’t matter (while, of course, to some degree it does very much). What I mean by this is that the macro trends that we have already seen were not going to change regardless of how the Supreme Court decided — trends such as the direction towards larger health systems with more points of care, more care delivery in non-acute settings and the concept of pushing care deeper into the community for full life-cycle engagement with patients.

But, having said that, there are certain things that may now change. It will be interesting to see how these unfold and will be harder to have consensus on these points. Still, I found a few comments heartening:

Moody’s investor service issued a statement that said that the impact of the decision will be neutral to slightly positive economically for the healthcare industry because expansion of insurance coverage “will lessen hospital operators’ exposure to bad debts, which in turn will improve margins and cash flow at for-profit hospitals.”

The President of Premier Healthcare Alliance issued a statement that the Affordable Care Act’s quality requirements, such as hospital value-based purchasing rules, creation of Medicare-based accountable care organizations and national pilots to test bundled payments “are important policy levers that are moving healthcare forward, and each of these enhancements has strong public and bipartisan support. Similarly, the creation of the CMS Innovation Center and increased investment in the development of quality measures are also necessary to increase transparency, reduce care variation and avoid unnecessary healthcare costs.

“Healthcare is our nation’s top economic issue, and the Court’s decision will help ensure that there is no loss of momentum … to improve the quality and affordability of care for Americans.”

All in all, we all within the industry have been talking for a long time about the need for a change in care delivery, alignment of incentives and economics. And this is a step. Whether it is viewed as a step forward or back will vary based upon personal and political views, but regardless, it is a step and having taken it creates an opportunity to take another one. I for sure will be interested to see how all of this unfolds and look forward to the challenge.


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