Any day now, the U.S. Supreme Court will announce whether the Affordable Care Act stands in part, in whole or not at all. The political stakes are high for both advocates of the law and its critics. However it goes, the ruling will not relieve the pressures that are compelling changes in the health-care system — the unsustainable cost, the disparities in access and health outcomes that do not match the outlays for care.
Studies indicate that among providers and payers, the growing dysfunctions in the system are prompting varying degrees of structural change — for instance, partnerships such as accountable care organizations. But, without question, the law has accelerated the momentum for reform. As the nation awaits word from the high court, the critical concern is not a ruling that fails to affirm the law and altogether derails reform. The worry is that the court could alter significantly the pace and the scale of change, dampening the progress evident with the phase-in of the law.
Much of the debate the past couple of years has focused disproportionately on the individual mandate (the requirement that citizens must buy some form of coverage if they are not insured through their jobs or some other organization or public program). But as important as the mandate is (it aims to reduce the incentive for healthier people to game the system, buying coverage only when they fall sick, a practice that raises the overall cost of insurance premiums), estimates are that it would affect a mere 2 percent of the population.
The reform law offers many provisions with a longer and wider reach. Speaking at the Akron Roundtable on Thursday, Mark Alkire, the chief operating officer of Premier, a national coalition of hospitals, noted that the essential challenge for the health-care system is to “move upstream,” to keep more people healthier at much lower cost.
For all its imperfections, the Affordable Care Act has put forward many tools that promise to quicken the movement upstream. It ramps up access to care for an estimated 32 million more Americans. Widely popular, for example, is the provision that guarantees children coverage under their parents’ policies until age 26. So is the provision that prohibits insurance companies from denying coverage to patients with pre-existing conditions or dumping sick policyholders. Less well-known, but as essential with the expansion of access, are the billions of dollars flowing to states for programs and services that would help increase the number and quality of services, for example, community health clinics in underserved rural and low-income areas or high-risk pools for those rejected by insurers.
The Affordable Care Act cannot — and does not — pretend to transform the nation’s health-care system overnight. What it does offer is a vehicle to move change along faster. The shame would be a ruling that smothers the potential.