Once again, the Supreme Court was unsurprisingly surprising. The conventional wisdom was that at least part of the health reform law would be overturned, but in practice the court blessed the status quo we have known for two years: The reform law will continue to be implemented.
It’s the devil we’ve known. Washington will issue more regulations. Insurers will be buried in requirements on coverage and benefits, driving up costs. Physicians will have more oversight and report to the government. Hospitals will see Medicare cuts. Millions of individuals will either get a new federal subsidy for insurance or be enrolled in Medicaid.
States will have more interference from Washington. While the Supreme Court gave them some flexibility on whether to expand their Medicaid programs, states will still be forced to either build a new insurance exchange, like Expedia for health insurance, or have the federal government build it for them.
By upholding the law, the court also left untouched two huge problems looming on the horizon. First, as the law expands coverage there will be a tremendous increase in demand for medical services, but there will not be an increase in the number of doctors, nurses and other providers to deliver care.
Millions of people may have very generous coverage, but they will struggle to find providers to deliver it.
Second, as businesses face requirements in 2014 to offer federally approved health insurance or pay a fine, many companies will do the math and see that paying the penalty is far less expensive than continuing to provide coverage.
Knowing that many of their employees can find insurance with a federal subsidy or enroll in Medicaid, many businesses will stop offering coverage. This will shift costs onto the government, exploding federal budgets and exacerbating our long-term fiscal crisis.
But there are health care trends that will be unaffected by the court’s ruling.
Costs will continue to be pushed onto consumers. Health care costs have continued their perpetual rise, leaving businesses with few options other than cutting benefits and shifting costs to their employees.
As a result, out-of-pocket spending is growing across the board. Consumers are paying higher premiums, co-pays and deductibles.
Since 2005, we’ve seen a significant increase in consumers managing more of their own health care dollars through high-deductible health plans with Health Savings Accounts. These consumer trends show no signs of abating.
How doctors are paid will change. Doctors and other care providers are currently paid for delivering specific, individual medical services regardless of whether they worked or were necessary.
Public benefit programs such as Medicare and private insurers are introducing new approaches that tie payment to performance and outcomes.
For example, WellPoint is leading 12 initiatives in eight states around a new payment and care model called Patient-Centered Medical Home. These types of programs reward doctors for improving patient care and lowering overall costs.
Silos of care will be replaced by coordinated care. How many times have you filled out the same medical forms over and over? That’s because very few doctors and hospitals share information or coordinate with each other on a patient’s treatment.
New partnerships among doctors, hospitals and community providers are popping up across the country that will better coordinate care from one provider to the next.
Health care will finally enter the 21st century with information technology. It often feels as if we walk back in time technologically when we see a doctor. But the writing is on the wall for patients being handed a clipboard and a pen.
Technologies such as electronic health records are key components for care providers to coordinate, and there are financial incentives to adopt and use them. New payment models for providers and the general march of technological progress will finally pull health care out of the dark ages and into the information age.
No Supreme Court decision could deter these changes, though some argue that upholding the health reform law will actually accelerate these trends.
David Merritt is the former CEO of the Center for Health Transformation and the Gingrich Group and currently a senior adviser at Leavitt Partners.