Supreme Court ACA Ruling Does Not End Physician Uncertainty

Many have hailed the Supreme Court’s ruling to uphold the Affordable Care Act as a historic decision that marks an end to the uncertainty surrounding the future of healthcare reform. 

But though it is true that the Obama administration is now one step closer to full-fledged implementation of the healthcare law provisions, physicians should proceed cautiously when it comes to preparing for them to take effect. 

In fact, Republican presidential candidate Mitt Romney has said numerous times that he will repeal the law if he ousts President Obama in November. “What the court did not do on its last day in session, I will do on my first day if elected president of the United States,” he said in a statement following the ruling. “And that is I will act to repeal Obamacare,”

And Charles Geyh, a law professor at Indiana University Maurer School of Law in Bloomington, told American Medical News that as both democrats and republicans move toward the elections, “… the debate is going to turn away from attacking the court for [its decision] and toward attacking each other over whether it’s a good idea, and what we should do in the new administration.”

Still, a full-fledged repeal of the law would be difficult for opponents to carry out. Republicans would need to win a 60-seat majority in the Senate to pass it and avoid the mess of trying to use budget reconciliation, according to The Hill.

Great Falls, Mont.-based neurologist Dennis Dietrich, who opposes the ruling, agreed that a full-fledged repeal will be difficult to accomplish.

“...The prospect of [overturning the bill] is remote unless there is a dramatic shift in the Senate after the November election and Romney in the White House,” he told Physicians Practice via e-mail. “The best we can be hope for is to try and preserve some of the freedoms that those in private practice still have and try to prevent the complete wholesale takeover of medicine with governmental regulations. It will be like trying to turn the Titanic! That didn't turn out too well.”

Indiana-based internal medicine physician and dermatologist Tamzin Rosenwasser, who also opposes the healthcare law, told Physicians Practice via e-mail that she hopes Congress will repeal the law and replace it with an alternative option, such as one proposed by family physician Rep. Paul Broun, (R-Ga.). 

“Getting rid of the entire bill will not solve all the problems, but it does give us a chance to put some meaningful reforms in place,” Rosenwasser said. “The problems were caused by unconstitutional, unwarranted government interference in medical care. However, the present occupant of the White House and most democrats in the Senate will probably not do the right thing and pass Dr. Broun’s bill. So, they must be voted out.”

Regardless of the outcome of the November election, there is one element of the healthcare law that will likely not be implemented at as large a scale as some anticipated.

That’s the Medicaid expansion portion of the law, which would broaden the federal program to cover individuals at or below 133 percent of the federal poverty level, and lead to an estimated 17 million additional Medicaid-insured patients. Now, due to the Supreme Court’s ruling on the health law, states may opt out of this expansion without risking federal funding penalties.

Republican leaders in at least four states (Florida, Ohio, Pennsylvania, and Colorado) have already said they are considering not participating in the expansion, according to the Washington Post.

And the number of states that decline the expansion may continue to grow. Just after the ruling was announced, Bob Keaveney, Physicians Practice editorial director, predicted that many states will not participate.

“...Opting out will quickly become a political requirement for Republican governors and legislatures,” Keaveney wrote. “Many strapped blue states may opt out, too. That is a very, very, big blow to the administration’s efforts to lower the rate of uninsured.”

Do you have plans to start prepare for the healthcare law provisions that will affect your practice? Why or why not?