Obama victory removes last major threat to ACA

The White House will pivot to implement reforms aggressively. Physicians hope the president will secure a permanent Medicare pay fix in his second term.

By — Posted Nov. 7, 2012

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President Obama in securing four more years in the White House removed the last element of uncertainty about whether the central provisions of the Affordable Care Act will go into effect starting in 2014.

In defeating former Massachusetts Gov. Mitt Romney, who had vowed to bring about the repeal of the ACA, Obama ensured that the implementation of the major health coverage expansion would go forward. In addition to the president’s veto powers, continued Democratic control of the Senate provides another safeguard against Republican lawmakers’ attempts to undo the statute.

Physicians on the one hand should be encouraged that Obama was re-elected and that health system reform will move forward, said Chantel Sheaks, a principal in government relations with Buck Consultants in Washington who specializes in health system reform issues. More people under the law will become insured through the Medicaid expansion and subsidized coverage under health insurance exchanges, meaning doctors will gain more paying patients, she said.

“But it’s yet to be seen what those payment rates are going to be” as the coverage expansions take effect, Sheaks said. The implementation phase is occurring as doctors continue to face potential Medicare pay cuts under the program’s sustainable growth rate formula.

Health system reform was the defining legislative achievement of Obama’s first term as president. With his re-election and continued Democratic control of the Senate, “the Republicans will have to concede that the law is here to stay,” Sheaks said.

Obama in his acceptance speech in the early hours of Nov. 7 put a personal touch on the law’s impact by describing how it helped an 8-year-old girl in Ohio with leukemia. The girl’s illness “nearly cost their family everything had it not been for health care reform passing just a few months before the insurance company was about to stop paying for her care,” he said.

With the possibility of ACA repeal out of the way, Bonnie Washington, senior vice president of consultant Avalere Health LLC, expects that the Dept. of Health and Human Services will move quickly in issuing guidance and regulations that had been delayed before the election. Timelines for crafting the health insurance exchanges and the Medicaid expansion probably will stay in place to ensure coverage for people starting in 2014, she said. The most immediate deadline is Nov. 16, when states planning to launch an exchange must submit a blueprint to HHS.

Some states will be prepared, but “it is too late for a lot of states to start from scratch their own state exchange process,” Washington said. Those states in 2014 will be required to accept a federally facilitated exchange.

The task of enrolling tens of millions of uninsured people in new health coverage will be the biggest challenge the law faces, said Ron Pollack, executive director of the advocacy group Families USA, which supported the ACA. “Since most of the uninsured are unaware of the new coverage opportunities that begin in January 2014, this will require a broad public education campaign coupled with a strong enrollment infrastructure.”

For physicians, the most immediate health policy concern postelection isn’t necessarily anything ACA-related, but rather the continued campaign to secure a permanent fix to Medicare’s SGR formula, said Washington, who leads Avalere’s health reform practice. This is not an issue “that’s particularly related to Obama versus Romney,” she said.

Physicians facing a nearly 27% SGR pay cut on Jan. 1, 2013, will be working to obtain a payment patch during the lame-duck congressional session expected to start Nov. 13, Washington said. Paying for the patch will be complicated by the fact that everyone’s attention is going to turn toward striking a deal on separate sequestration deficit cuts that potentially could translate into large cuts to Medicare and other government programs, she said.

Several physician organizations made an appeal to Obama to address the SGR in his second term. In congratulating the president on his win, American Medical Association President Jeremy A. Lazarus, MD, emphasized that it was time “to transition to a plan that will move Medicare away from this broken physician payment system and toward a Medicare program that rewards physicians for providing well-coordinated, efficient, high-quality patient care while reducing health care costs.”

Other health organizations stressed the importance of stabilizing funding for public insurance programs. “While we know that the president and our newly elected Congress must find ways to reduce federal spending and fund a wide variety of programs, now is the time to take a hard look at meaningful reforms to solve the issues that face both the Medicare and Medicaid programs,” said Mark Parkinson, president and CEO of the American Health Care Assn., which represents skilled nursing facilities.

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