Behind the Waning Support for ACA's Individual Mandate

Just read what Senior U.S. District Judge Roger Vinson wrote in a 78-page ruling. "This case is not about whether the Act is wise or unwise legislation. It is about the Constitutional role of the federal government. Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void."

The ruling will likely be appealed by the federal government at the U.S. Court of Appeals in Atlanta, and the case is expected to be heard eventually by the U.S. Supreme Court. It'll make it that far, bet on it.

Speaking of betting, I don't know whether they're taking bets on this in Britain, where the off-track betting parlors will take a wager on just about anything, but I'll be the odds are against the law surviving, given the Court's current 5-4 split, Republican to Democrat.

So does that put us all back to square one if the law is struck down on Constitutional grounds? In some ways, yes. The uninsured would remain uninsured, I suppose. Insurers could go back to their old way of doing things. And hospitals' bad debt expense (as a result of those uninsured seeking care without any means of paying for it) wouldn't be cured anytime soon either.

Much of the focus on cost and quality doesn't depend on the legislation's survival. In fact, despite its huge scope, cost control and quality were two big items that left a noticeable hole in that many feel they received short shrift in the legislation. Commercial payers, and even CMS, will move forward on many of these efforts regardless of what happens to PPACA. Many of the more innovative hospitals and health systems are re-engineering to meet these new standards. So stay tuned. If you thought last year's progression toward the legislation's actual passage was turbulent, you've seen nothing yet.

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