June 24--All eyes this week are on the U.S. Supreme Court, which is widely expected to rule on President Barack Obama's controversial health care reform law.
In what could be its biggest decision in more than a decade, the court will shape not only the course of this year's presidential election, but also define the future of health care for generations.
No one, other than the justices themselves, knows how the court will decide.
It could uphold the Affordable Care Act, perhaps by postponing a decision. It could strike the law down in its entirety. Or it could strip away key provisions, especially the law's controversial individual mandate -- the requirement that every American obtain health insurance.
No matter how the court rules, health care providers will be among the first to feel the impact of the ruling -- and its outcome likely will transform health care in Memphis and Tennessee. But the size and scope of that change will be different for different organizations.
For example, the thousands of hours and millions of dollars -- mostly federal dollars -- spent to design Tennessee's health insurance exchange is now clouded in uncertainty.
A memo issued last week from the Tennessee Insurance Exchange Planning Initiative gave three scenarios for its future for each of the three possible court rulings.
If the law is upheld, planners would continue on with their work and expect truckloads of policy directives and guidance documents from Washington to finalize the exchange.
If the law is struck down entirely, the exchange's future is "unclear," as lawmakers might come up with some other way to implement the exchanges.
And if the mandate is struck down but the rest of the law stands, things will be even more muddled -- and there won't be any answers to any key questions anytime soon.
"Given the complexity of these issues, we will need several weeks after the release of the court's decision to determine the impact of the ruling," said the planners' memo to stakeholders.
U.S. Rep. Stephen Fincher said he and other House Republicans weren't taking a wait-and-see approach to a court ruling.
In Bartlett earlier this month, Fincher told a group that he and others were already hard at work on a contingency health care plan should the Affordable Care Act be struck down.
Their plan, he said, contains "some good parts" of Obama's health reform law, such as allowing children to remain on their parents' health plans until they are 26 and doing away with coverage exclusions for patients with a pre-existing condition.
"Hopefully, we're putting together something the private sector will be able to get their heads around and that will be best for the patient," Fincher said.
A number of major insurance companies already beat lawmakers to the punch. UnitedHealthcare, Humana and BlueCross BlueShield of Tennessee all said earlier this month that they will continue to cover children up to age 26 on their parents' plans, cover preventive care, offer a simple process for appeals of denied claims and other provisions of the ACA.
BlueCross was an early supporter of health reform and said the provisions they voluntarily adopted "are all important elements in making sure people get the access to care they need."
But Ron Pollack, executive director of the national health care consumer advocate Families USA, warned that the companies could just as easily voluntarily do away with the provisions if they're not profitable.
"That's why it's much better to have an industry-wide practice so that all insurers are on the same competitive footing," Pollack said.
The court's ruling is especially important in Memphis, the major health care hub for the Mid-South. The region is home to more than 20 hospitals from Tenet Healthcare Corp., Methodist Le Bonheur Healthcare, Baptist Memorial Health Care Corp. and others, hundreds of clinics, the University of Tennessee Health Science Center medical school and a host of medical researchers.
Memphis is also the base of operations for three leading medical device makers -- Medtronic, Smith & Nephew and Wright Medical.
Together, these organizations make health care one of the top employers in the Mid-South and certainly in Memphis.
The court's decision will direct them on how they do business. The ruling will determine how each organization gets paid, how many patients they serve and how they serve those patients.
Right now, health reform ensures that more than 550,000 Tennesseans would gain coverage, and that could be a boon for hospitals and doctors, according to a January report from the University of Memphis. With more patients able to pay their medical bills, the amount of uncompensated care and bad debt to health care providers would be reduced from $4.11 billion to $1.84 billion, the study said.
At the same time, however, more people with access will put a strain on the state's health care workforce, requiring 194 new primary care physicians for an adequate workforce level, the study said.
The Affordable Care Act was designed to address both access and capacity, and it's provided a steady stream of funding to support a range of health care initiatives since it was signed into law, in 2010.
Here, according to the U.S. Department of Health & Human Services, the law has already meant $5.9 million in innovation grants to Memphis researchers and grants of more than $15.7 million to three Memphis area health centers.
Because the Affordable Care Act has required insurers to spend most of their premium income on health-related expenditures, thousands of policy holders in Tennessee and across the country will get refunds this year.
And the law has enabled more than 336,000 Tennesseans to get free preventative health services.
Whether the spigot of federal dollars gets turned off by the court remains to be seen.
Dr. Scott Morris, executive director of the Memphis-based Church Health Center, said he's interested in but not worried about the Supreme Court's ruling. No matter what happens in Washington, his center will remain and remain needed, he said.
If health reform is struck down, he and his staff will continue to care for the working uninsured in Memphis. If the law is passed, it will help, he said, but "the Church Health Center is not going out of business."
"Jesus said the poor will always be with you and so far he's been right," Morris said. "Even after the Affordable Care Act, there will be millions of people who remain uninsured."
Even after the Supreme Court rules, the fight over reform is far from finished. If the Affordable Care Act survives the Supreme Court, Republican opponents in Congress will still fight to hold up its implementation and push for repeal.
If the court strikes down the law, it could energize Democratic voters in the 2012 election with an eye toward changing the future direction of the high court.
-- Toby Sells: (901) 529-2742
(c)2012 The Commercial Appeal (Memphis, Tenn.)
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