Richard Mckeown, a co-founder along with former Health and Human Services Secretary and former governor of Utah Michael Leavitt, explained the way some conservatives were reacting to the surprise decision by the United States Supreme Court to uphold President Barack Obama’s Affordable Care Act by likening it to a bear attack.---
“What you ought to do if you encounter a bear is to act big, raise your arms and back away slowly,” Mckeown said at the forum Thursday. “If the bear attacks, assume the fetal position -- I suspect there are a lot of people who feel that way today in wake of this decision.”
While the Supreme Court’s decision today to uphold the individual mandate in the 2010 Affordable Care Act came as the kind of surprise that may have left many conservatives curled up in the fetal position, Mckeown and others in the state health-care field acknowledged that the decision will not greatly change the trajectory that local hospitals and health-care providers have been headed toward, with all panelists representing Utah’s largest hospital chains and health-care companies admitting that the system has been in need of change since prior to ACA’s passage.
The panelists at the forum sponsored by the public-policy nonprofit the Utah Foundation acknowledged that reforms are already in place to move the country’s health-care system toward one that rewards providers who prevent health problems, instead of a system that profits from costly surgeries and procedures for when a problem has gone on long enough. While the nation’s health-care system has suffered for a long time, some on the panel, like Judi Hilman of the nonpartisan Utah Health Policy Project, celebrated the Supreme Court’s decision to clear the way for change.
“We want the private market to be the foundation of a reform of the health system,” Hilman said. “If there was a way to achieve that -- then that’s what made its way into the Affordable Care Act. It’s not an accident that the blueprint to the Affordable Care Act was ‘Romneycare’ and that’s working well,” she said in reference to the state health-care exchange founded by former Massachusetts Governor Mitt Romney that required residents to have insurance or pay a fine.
A similar component was a sticking point in the President Obama’s ACA that required a penalty be levied against those who don’t buy insurance under the act.
In a surprise decision Thursday, the Supreme Court voted 5-4 that the “individual mandate” was constitutional as a tax. Hilman worries about other implications of the ruling, namely the justice’s ruling that the federal government couldn’t force states to expand Medicaid coverage through threats of pulling federal funding.
But she also sees this as an opportunity now that the issue has been settled legally for other states to join Utah by creating their own health-care exchanges that will develop state-specific solutions, while still abiding by the major tenets of ACA.
The health-care experts of the panel all agreed that the system of delivering services in the country that is geared towards costly tests, surgeries and procedures, as opposed to getting the cheap and regular checkups that help prevent emergency-room crises, was the major reform, but some argued ACA would have less a role in changing that system than market forces would.
Gregory Poulsen, senior vice president of Intermountain Healthcare, described the current model by pointing out that a physician who performs a costly and perhaps risky procedure on a patient is paid much more to do so than had the physician consulted seriously with the patient about the preventative steps to keep the patient away from the surgeon’s knife.
“If I have a choice of sitting and consulting with a patient and working with them to see how they can change their life versus doing the procedure -- I get paid six times as much doing the procedure than the consultation,” Poulsen said. “It is a shock that we as patients lean toward getting something done to us, as opposed to doing something to ourselves.”
John Hanshaw, President of MountainStar Healthcare, says that the Supreme Court’s ruling would not have changed the direction his company has been moving toward as far as reforming health care away from a pay-for-service model. He did commend the ruling, though clearing the way for ACA to be fully implemented, which should encourage more hospitals and health-care providers to focus on wellness and prevention instead of costly last-minute procedures.
“At some level, market dynamics have to work in health care to lower the costs,” Hanshaw said. “I think the right incentives are in place around the [ACA] to allow that to occur.”
Kim Wirthlin, associate vice president of public affairs for University of Utah Health Care, argued that the large price tag associated with ACA will diminish over time by virtue of the fact that “more access to coverage, for more people over time reduces cost,” Wirthlin said, arguing that people who gain access will begin to treat their health care differently and will take a part in working toward their own wellness.
For Hilman of the Utah Health Policy Project, the Supreme Court’s ruling on ACA means the medicine is going down, perhaps not smoothly for most conservative politicians, but it will go down. She hopes that the market-oriented approach ingrained in the president’s ACA will be embraced once again by conservative groups such as the Heritage Foundation and others who previously supported the idea before it was taken up as the centerpiece of President Obama’s 2010 health-care reform.
“I want to get back to that moral awakening,” Hilman said. “Now, let’s roll up our sleeves, get this thing implemented and take it as far as we can go.”