New reporting published July 11 in the journal HealthAffairs has found that after the Supreme Court’s decision upholding the major part of the Patient Protection & Affordable Care Act, President Obama’s signature Health Care Law, a sharp partisan divide still dominates public discussion, but behind-the-scenes, the major stakeholders that will implement the law are surprisingly unified in favor of the law.
The authors note that while politicians and the public remain divided about implementation of the Health Care Law, largely along partisan lines, health care stakeholders–insurers, employers, and providers–are “converging on the conclusion that reform is a better option than reverting to the status quo before 2010.”
The article, “In The Wake Of The Supreme Court Decision, Many Stakeholders Still Support The Affordable Care Act,” by Joel Ario, a managing director of Manatt Health Solutions, in Washington, D.C. and Lawrence R. Jacobs, director of the Center for the Study of Politics and Governance in the Hubert H. Humphrey School at the University of Minnesota, in Minneapolis, appears in the July 2012 online issue of the journal HealthAffairs.
In the article, the authors examine the positions of health care providers, medical associations, insurers, employers, employer groups and trade associations — the major stakeholder groups that will be required, following the Supreme Court’s decision, to implement the Health Care Law.
“In this article we provide evidence of stakeholders’ positions based on their activities, statements, reports, and Supreme Court briefs. We also rely on information derived from interactions we have had with stakeholders since the law’s enactment,” the authors explain.
The authors acknowledge that public commentary on the Supreme Court’s ruling upholding most of the Health Care Law has been sharply divided along partisan lines.
Republicans in the House of Representatives have even conducted a meaningless and symbolic vote – yet again (this is the 33rd time) – to “Repeal Obamacare” in its entirety. Republican Presidential Candidate Mitt Romney vows to “Repeal and Replace Obamacare” — although he fails to say in any detail what he would try to replace it with.
However, the authors found that the major stakeholders who are charged with implementing the law — health care providers, medical associations, insurers, employers, employer groups and trade associations (even now including the U.S. Chamber of Commerce!) — are now largely unified in support of the law.
The stakeholders have accepted that they are largely better off under the new law than under the laws and system that existed before the law, and they have moved on to focusing now on lobbying to influence the extensive regulations required to implement the law, for their own interests.
“The partisan opposition to implementing the Affordable Care Act is mostly devoid of major interest-group support,” the authors state.
“Stakeholders are certainly not without reservations and uncertainties and are not a monolithic group proceeding in lockstep. However, their approach has been to “mend it, not end it,” by lobbying to negotiate particular provisions to improve their specific interests,” the authors write.
Based on their research, the authors conclude:
Many stakeholders see reversion to the status quo ante—to what existed before 2010—as unattractive and premature. Repeal would terminate benefits they expect to see from the Affordable Care Act and put a stop to negotiations that are softening burdens and making those burdens less threatening.”
The authors further conclude that the behind-the-scenes collaboration among stakeholder groups will, in their view, “make repeal of reform more daunting than expected.”
Here is a summary of additional findings in the new report, from a news release issued by HealthAffairs on July 11:
- “Insurers: While some worry the penalties for noncompliance are too weak, others in the industry, said the authors, “view the status quo before 2010 as posing more risks and less upside in terms of new customers and revenue streams.”
- Providers: Most hospital organizations and the American Medical Association have supported the ACA as ways to reduce uncompensated costs from uninsured care, improve health quality, and achieve delivery reform. Among physician groups, there is a divide between primary care providers and specialists: organizations such as the American College of Surgeons have opposed the ACA, raising concerns about greater regulation and lower reimbursement.
- Employers: While many employers “cringe at the prospect of higher taxes,” the authors state that many “recognize the virtues of the Affordable Care Act’s initiatives–the most comprehensive to date–to control health care costs….The combination of new opportunities and the breakdown of the old system of financing prodded the Chamber of Commerce to suspend its earlier opposition to the mandate.”
- Patients: Despite polls showing divided public support for the ACA, the authors find “diffuse but broad-based organizational push for patients’ interest in health reform.” In the past several decades, employers have passed along rising premiums to employees. Still, the authors note that while many state markets currently offer inexpensive insurance plans for younger workers, older workers at the moment do not have those options, causing some older Americans to reluctantly retain their jobs (and employer insurance) until reaching Medicare eligibility.”
“In a break from the usual dynamics of battles among interest groups,” the authors state, “the Affordable Care Act proposes to transfer resources from organized and affluent ‘haves’ to a more diffuse groups of ‘have-nots.’ However, “At the same time, powerful interest groups continue to pursue adjustments,” the authors observe, “since when it comes to implementation, power often translates into the ability to work effectively behind the scenes and out of the public glare.”
The article, “In The Wake Of The Supreme Court Decision, Many Stakeholders Still Support The Affordable Care Act,” can be read in its entirety in the July 2012 online issue of the journal HealthAffairs.
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For a summary of what is in the Affordable Care Act, see SUMMARY OF NEW HEALTH REFORM LAW, a paper prepared by the Kaiser Foundation (13 page PDF document – Last updated April 15, 2011). See also The Health Reform Source, a website maintained by the Kaiser Family Foundation providing comprehensive news and information on the Health Care Law and health reform.
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