Anesthesia Business Consultants Discusses the Supreme Court Ruling on the Affordable Care Act

JACKSON, Mich.--(BUSINESS WIRE)--The Supreme Court is expected to rule early next summer on the constitutionality of the Affordable Care Act (the “ACA”). The Court is expected to uphold the ACA, invalidate it in part, or decide that the entire statute must fail.

“The Obama administration insists that if the mandate falls, so does the provision on pre-existing conditions”

Twenty-six states and the National Federation of Independent Business have joined in the challenge to the ACA’s requirement that all persons carry health insurance or pay a penalty starting in 2014. There are four specific questions before the Court:

1. Does the United States Constitution allow Congress to require all persons to have health insurance -- to impose the “individual mandate” -- by 2014?
2. If the individual mandate is unconstitutional, can it be severed from the rest of the ACA, or must the entire statute fail?
3. Is the issue “ripe,” or should the decision be delayed until the first taxpayers might pay a penalty for not having health insurance. i.e., in 2015? and
4. Can Congress force the states to pay the extra cost of expanding the Medicaid program?

Predicting the Supreme Court’s decision is going to become a popular sport at least in and around Washington over the next few months. Although five of the nine justices were appointed by Republican presidents, one or more of them could join the Court’s four liberals in upholding the ACA.

If the individual mandate is struck down, the ACA may not survive. “The Obama administration insists that if the mandate falls, so does the provision on pre-existing conditions,” according to a news analysis published in the New York Times on November 15th. The health insurance industry supported healthcare reform, including the elimination of exclusions for pre-existing conditions, only because of the individual mandate.

Unraveling some of the changes already made under the ACA would be complex. The White House estimates that one million more young adults under the age of 26 have health insurance because of the law. Would their premiums skyrocket and make continued coverage unaffordable? Other segments of the population have already become accustomed to having certain preventive health services paid for. The American Medical Association endorsed the healthcare reform legislation in part because of the promise of near-universal insurance. Whatever is left of physicians’ support is likely to vanish if the Medicare payment formula, including the Sustainable Growth Rate formula, survives but universal coverage does not.

The Medicare Shared Savings Program could lose its statutory foundation – but Accountable Care Organizations (ACOs) have their origin in private sector initiatives, and the drive toward greater accountability and “value” in health care is by now thoroughly embedded in our health care system. Next summer’s Supreme Court decision may change the course of national politics, but it will not diminish either the challenges or the opportunities for anesthesiologists.

See Anesthesia Business Consultant’s full discussion of the Supreme Court’s review of the ACA here: http://www.anesthesiallc.com/publications/ealerts/295-how-will-the-affordable-care-act-affect-anesthesiologists-after-the-supreme-court-rules

About Anesthesia Business Consultants

ABC, established in 1979, is one of the largest billing and practice management companies dedicated to the complex and intricate specialty of anesthesia and pain management. It is both an American Society of Anesthesiologists Practice Management Supporter, and an Anesthesia Quality Institute Preferred Vendor. ABC employs industry leaders, operates under proven efficient processes, and utilizes technology advances to easily adapt to the ever-changing regulatory environment.

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