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HL20: Supreme Court—Court's Decision Reduces Uncertainty, Somewhat

Philip Betbeze, for HealthLeaders Media, December 13, 2012

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of the Supreme Court.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "Reform is going to occur one way or another and we would rather have planning and thoughtful preparation to deal with it."

When, like the unseen men in the instant replay booth of the NFL, the Supreme Court decided to weigh in on healthcare reform legislation, many would like you to believe that a hush fell over the crowd as the players stood on the sidelines and waited for the decision. But the replay of healthcare reform legislation before the highest court in the land was anything but instant. Hospitals, health systems, employers, and payers had to muddle through. What kept them driving is not only the relentless march of ever-higher healthcare costs, and the persistent questions about the quality of that care, but also the hope that  a confluence of technological and evidence-based treatment protocols is ready to finally deliver improvement on both fronts. Still, the justices' decision to review the Patient Protection and Affordable Care Act led to widespread uncertainty about how hospitals, health systems, and indeed, any entity associated with the business of healthcare, should alter its strategic plans. And that waiting game went on for many months. Because the ultimate decision clarified what the law is able to do—namely, to force people to obtain health insurance or pay a penalty—and what it is not able to do—namely, to force states to expand their Medicaid eligibility rules—the decision deserves a mention as the most impactful of the year, if not the decade.

Clearly, there is no unanimity of opinion on the matter—among the justices themselves or the members of the healthcare industry itself—but the fact that the decision allows reform to proceed under some certainty is why many hospital and health system leaders are grateful.

"The need for reform and the reform process had begun even before the passage of ACA," says Michael Schnieders, president and CEO of Good Samaritan Hospital in Kearney, Neb. "The ACA accelerated that rate of change. The Supreme Court came out with its ruling giving direction on the federal level, and we can continue our reform. Uncertainty remains at the state level regarding Medicaid expansion."

 

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