Reform Provisions that Live or Die on Court Ruling

What Stays? What Goes? What Stays? What Goes?

Provisions in the Affordable Care Act are in limbo pending a Supreme Court ruling on the law’s constitutionality. Some provisions have wide support that could compel congressional reauthorization, others could bring unintended results if they no longer are in force.

Here’s a look at what could happen if the court rejects some or all of the law.

Bumpy Road for Population Health Management? Bumpy Road for Population Health Management?

ACOs are all about population health management, so while Medicare ACOs may need congressional reauthorization, commercial and Medicaid ACOs could continue. Medicaid ACOs, however, may not work without the Medicaid expansion provision.

Adult Children Adult Children

The reform law enables parents to cover adult children up to age 26. This helps families and having the young and healthy insured could offset insurers’ costs for covering less healthy populations, which is a critical goal of the legislation and plays into myriad federal and private efforts to manage populations on a much broader scale.

Individual Mandate: Here Today, Gone Tomorrow Individual Mandate: Here Today, Gone Tomorrow

The individual mandate paved the way for covering consumers with pre-existing conditions. They won’t be pleased if that coverage is no longer available. Nor will others if coverage of preventive services goes away.

Hits to HIT if Individual Mandate is Struck Down Hits to HIT if Individual Mandate is Struck Down

Loss of the individual mandate would hit HIT initiatives hard, says consultant Paul Keckley of Deloitte. Bad debts will only get worse, complicating efforts to fund costly initiatives. “The commitments to HIT will have to be less.”

Hitting the Brakes? Hitting the Brakes?

Under the reform bill, bad debt is expected to slow considerably between 2014 and 2016 as more patients are insured. If that doesn't happen and bad debt unexpectedly spikes, providers would have to reprioritize spending plans, so discretionary investments, such as I.T. initiatives linked to health reform, would be at risk.

Popular HIT Initiatives Likely Would Continue Popular HIT Initiatives Likely Would Continue

HIT provisions with wide support beyond health reform include EDI operating rules, new HIPAA transactions for EFT and claims attachments, Medicare claims data availability and expanded analytics, and electronic enrollment in health and human services programs. Experts predict that momentum for seeing those come to fruition would continue no matter what the fate of the health reform law.

But Not-So-Popular Initiatives ... But Not-So-Popular Initiatives ...

Support is debatable for the health plan identifier, state insurance exchanges, and especially a new tax on medical devices including those that collect and/or transmit data. Absence the force of law, those efforts would be in jeopardy of being shuttered.

Change of Power? Change of Power?

Finally, if the court upholds all of the law, will Republicans still repeal ObamaCare if they sweep the 2012 elections? Repeal is a core promise of the party on the campaign trail.


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