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June 29, 2012

After the ACA Ruling: Bipartisan Consensus on Health IT

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Dissecting the Decision

Yesterday, as the Supreme Court upheld the vast majority of the Affordable Care Act (ACA), a couple caveats were highlighted in the court’s ruling. Regarding the mandate, most people understand the law is economically sustainable only if all citizens participate. The court established that the penalty to be paid by those citizens who refuse to acquire health insurance essentially amounts to a “tax.” Therefore, congress was within its constitutional rights to include such a mandate/tax/penalty in the law.  Although to some it may seem the Supreme Court’s ruling was based partly on semantics, ACA proponents declare it a victory since everyone was previously burdened with the shared costs of caring for the uninsured by way of increasing hospital charges and insurance premiums.

The court also ruled that expansion of Medicaid to offer more citizens health coverage may proceed, but without the ACA stipulation that US states that don’t comply would be denied matching federal funding for their original Medicaid programs. So states may now choose whether to participate in the federally-funded expansion.  Note:  the ACA already included a similar provision (Section 1332: Waiver for State Innovation) that allows for states to opt out so long as they offer citizens the same level of quality care at a cost that is equal to lesser than the ACA, but not until 2017.

Looking Ahead

As focus shifts from the law’s credibility to its timely implementation, Health IT will play a prominent role in the delivery of affordable care to more than 30 million new customers. Many provisions of the ACA rely heavily on IT to raise awareness, determine eligibility, manage payments, improve decision-making, measure quality, and more.
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I recently moderated a two-day conference on Government Health IT in Washington DC where Janet Marchibroda, Health IT Chair at the Bipartisan Policy Center (BPC), spoke on the topic.

Ms. Marchibroda presented “Transforming Health Care: The Role of Health IT,” a recently released report from BPC’s Task Force on Delivery System Reform and Health IT. The report detailed six barriers to achieving Health IT capabilities needed to support the common attributes shared among the nation’s highest performing health care organizations, and included recommendations to address each.

Barriers
1. Misaligned Incentives
2. Lack of Health Information Exchange
3. Limited Level of Consumer Engagement Using Electronic Tools
4. Limited Levels of EHR Adoption
5. Privacy and Security Concerns
6. Multiple Federal Priorities Requiring Focus and Attention

Although it doesn’t compete well for attention-grabbing sound bites in today’s twenty-four hour news cycles, most technologists I speak to are encouraged by continued bipartisan acknowledgement that Health IT provides immeasurable value in the quest to improve the nation’s healthcare systems.

Admittedly, there are significant ideological differences and varying perspectives that will play themselves out in the coming elections and other political processes. But after the rhetoric and dust settles, regardless of political affiliation, most stakeholders can agree that now the real work begins…

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