Whether you love or hate healthcare reform, you should rest assured that the investments you're making on quality and care coordination are worthy ones, because when Republicans tell you the reform law be repealed, don't fall for it. I don't think they really believe it.
Like many of you, I try to tune out the political gasbags during most seasons in my life. Of course, primary season when most of the gas is expelled, ad nauseum. I reluctantly pay attention when it comes to election season, but I start with the presumption that a politician is lying to me, at least in some way, and I make my decisions from there.
As we watch the Republican primaries to determine which candidate will oppose President Obama this fall, I have paid attention, at least as far as the conversation concerns healthcare. Hopefully the rest of you are not quite as cynical about our democratic process as I am, but here's why I think that, as a group, they're lying about repeal.
Healthcare, and repeal of the Patient Protection and Affordable Care Act of 2010 specifically, is playing a huge role in the primaries so far. That's not surprising. The vast majority of Republican voters hate "Obamacare," and each candidate pledges that if you'll elect him president, they'll repeal it.
Never mind that Congress is the only authority that can do this. Secondly, though Congress can cause problems in its implementation in other ways, it would be tough to repeal entirely, because 60 Senate votes would be required.
Many say this could be circumvented by using budget reconciliation, because the bill was enacted that way. The bottom line is that though a plan has been outlined by which a repeal could be done, what are the odds?
Vegas is pretty good at this and could probably do better than me, but since they don't release gambling odds on political promises, I'd put the likelihood of repeal through reconciliation at 10% or less. Speaking of which, if you like to gamble on political outcomes, there are much easier ways of doing so, as many of our Congressional leaders have so recently and pathetically demonstrated.
But back to the subject at hand.
So I'm predicting they'll try to repeal, but they won't try very hard. What's easier? Repealing and replacing the ACA with something else, or making a halfhearted attempt at repeal so that you can still blame Democrats wherever the law screws up? I think you know the answer.
We already know how the majority of you feel through our surveys, in which only 41% of you said you wanted the law repealed. Because its provisions so drastically affect the way you run your business, you've likely been up to your ears in leadership—and financial—issues that stem from both the Act and a few other government regulations you have to comply with in a very short time, such as ICD-10 and the HITECH Act.
As a result, those who want repeal from your ranks are likely even smaller now because of the uncertainty it would create surrounding long-range planning and investments.
As I mentioned, I'm not a political expert, nor do I play one on TV. I also slept in my own bed last night, not at a Holiday Inn Express. So take this prediction with a grain of salt, but I don't think healthcare is really a core issue in this election, especially, as looks increasingly likely that former Massachusetts Governor Mitt Romney will win the GOP nomination.
Republicans are clearly playing to their base when they talk about repeal, but history shows that anything that gives something to voters is very infrequently repealed. Never mind that Romney's the guy whose lasting political legacy is the creation of "Romneycare" in Massachusetts, a universal coverage law that it very similar to "Obamacare" in that it's largely intended to provide "coverage" to the uninsured.
In that regard, it has succeeded. But in large part, coverage is in the eye of the beholder. For hospitals and health systems, it means largely playing games with the same pot of money. Revenue is largely the same, but the number of patients for which they get some payment is increased. Some deal.
Never mind that Romney's legacy has been plagued by cost overruns since it started. Other surveys show that the majority of people like the provisions in the ACA that, for example, eliminate screening for pre-existing conditions by insurers, and that force businesses with more than 50 employees to either provide insurance or pay a penalty.
The one part the majority consistently opposes: the individual mandate, the constitutionality of which the Supreme Court has yet to rule on. Once you give something to people, especially when it absolves them of some responsibility, it's hard to take it back.
Finally, to stay in power, Republicans would likely have to replace the ACA with something else. After all, with apologies to Ernest Hemingway, the existing "system" was first slowly, then quickly, bankrupting us as a nation. If we do go back, where does that leave hospitals and health systems that have invested copious amounts of time, money and talent into readying and reinventing themselves for the changes? I'm not sure, but I can guarantee it would be a very bad place.
So for all these reasons, and despite all the bloviating about healthcare from your national candidates for the office of president, don't believe it. I don't think they do.
Philip Betbeze is the senior leadership editor at HealthLeaders.