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So the Supreme Court ruling – finally – has been handed down and the verdict is out: Chief Justice Roberts' hand pulled the ACA to shore.
How do officials in the public health sector feel about the final 5-4 decision? For the most part, positively – though many officials emphasize it’s just the first step on a long road to reform.
"I'm glad the Supreme Court made a sensible ruling,” said Robert Califf, M.D. and vice chancellor for clinical and translation research at the Duke Translational Medicine Institute. “The only way to really achieve major improvements in population health will be to ensure that everyone has access to preventive and primary care.”
Gearing up for its 2014 execution date, Califf said, “There are many aspects of the law that now need to be improved as the implementation rolls out."
Echoing Califf’s positivity is William Pilkington, CEO of the Cabarrus Health Alliance in North Carolina (pictured at right). “This is a great success for the area of public health,” he said. “This gives us the opportunity to provide health care for many underserved populations.”
Cabarrus County’s “Community Care Plan” ensures non-episodic care for those who need it, Pilkington said. To that end, the expanded coverage of the ACA will not have a huge impact in Pilkington’s neck of the woods, he added, “but it will have a huge impact in lots of communities where that’s not available.”
A few states north, Michigan’s Department of Community Health is also looking to the ACA as a catalyst for positive change. “Michigan’s greatest health care opportunity today is prevention in terms of both personal quality of life and societal costs,” director Olga Dazzo explained.
With the final decision officially published, Dazzo called for state officials to thoroughly evaluate the ruling, and agreed with Governor Rick Synder’s similar demand. “Now that the Supreme Court has essentially upheld the Affordable Care Act, we need to thoroughly review the decision and analyze the impact,” Dazzo explained. “As Governor Synder has said, we will work with our legislative leaders, consumers, businesses and health providers to best serve Michigan residents and ensure that the decisions we make have as much of a positive impact on Michigan as possible.”
[See also: Q&A: We now have a framework for health reform.]
Like Cabarrus’s Pilkington, Charles Christian, CIO of Good Samaritan Hospital in western Indiana and former CHIME and HIMSS CIO of the year, says his organization already has a foundation in place to generate reform – regardless of the ACA. “We have a strategic approach to the way we go about providing healthcare for our community,” he said. “We’re going to do that regardless of the ruling.”
The bill contains “very strong” pieces notwithstanding its impact on Good Samaritan, Christian said. He highlighted its provision allowing adult children up to 26 years old to remain on their parents coverage plan, as well as its provision on patients with pre-existing conditions. “I have four daughters,” he said. “We’ve had to pick up additional coverage for them the last years of college until they became employed. I’ve also got coronary artery disease, so that would be viewed as a pre-existing condition if I changed employers. There are some very good parts to the bill.”
Christian said fellow CHIME members and physician colleagues mirror Good Samaritan’s position. “Everyone is doing exactly the same thing we are – the folks that I’m talking with – related to moving their organizations forward, and rolling out the technology.”
Now that the wheels are already in motion - and that motion’s made official with the SCOTUS ruling – Roger Foster, senior director of DRC’s high performance technologies group, is looking to IT as the key driver of future change.
"HITECH and ACA are two pieces of legislation that have driven health IT reform, the move to EHR and better use of data,” Foster said. “While the Supreme Court upholding ACA is a positive development from a health IT perspective, HITECH is the critical legislation."
Christian agreed. Now that reform legislation is gaining teeth, he’s pushing for increased emphasis on technology rollout. “Those in health care IT have kind of long been proponents of utilizing technology to impact how we provide care for our patients. And that’s what it is, a tool,” he said. “We have to have good data that’s standardized, that’s built upon specific criteria that we can do comparative analysis with.”
With the ruling finally clarified, said Steve Furr (pictured at right), physician at IMC Family Medical, a physician practice in Jackson, Alabama, at least the waiting game is over. “We created this whole cloud over healthcare where we weren’t going anywhere for the last year,” Furr said. “We were just waiting.”
But diffidence in the industry remains, Furr continued, even with the final announcement. Like the other officials, he’s looking as the act as a stepping-stone on a longer, involved path to shaping the system.
“I think there are still a lot of unanswered questions. With the Medicaid expansion, and all the pieces, I hope it’s a good starting point,” Furr said. “The bottom-line is, it really doesn’t matter how you feel about it, it’s going to move forward in one way or another.
For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.