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4 Health Care Stories (3) 1

4 Health Care Stories (3) 1

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Published by: Michael Robert Hussey on Jan 24, 2012
Copyright:Attribution Non-commercial


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4 Health Care Storiesto Watch Out for in 2012
What will the big stories be for the Affordable Care Act (ACA) in 2012? Access,affordability and quality win the day. The ACA year opens with a scintillatingGOP primary and election year intrigue; and the Supreme Court hearsarguments on the “individual responsibility” requirement and the constitutionalityof the Act.Through the year, sweeping Medicare quality and cost reduction projects roll outfocused on financial rewards to health care providers for keeping patientshealthier, reducing hospital reimbursement for avoidable readmissions, helpingseniors receive care in their homes, cracking down further on waste, fraud andabuse, and continuing to close the donut hole gap in medication coverage.Pharmaceutical companies start coughing up some money for branded productspurchased outside of the country; and insurers start funding comparativeeffectiveness research aimed at answering questions about which treatments aremost effective.The states continue to ready themselves for the health exchanges due to go livein 2014. And a diversity database is established with the goal to reduce the gapin getting good health care for minority groups.All tolled, 2012 is focused on continuing to improve access, quality andaffordability.Here’s a look at the top stories.
The Supreme Court ruling
: More than 100 law professors, 35economists, and three Nobel Prize winners say there’s no doubt the newhealth law is constitutional. A majority of bipartisan circuit court judgeshave ruled in favor of the law’s “individual responsibility” requirementwhere everyone must have health insurance. This is an essential elementof the Act, without which its goals to improve access, affordability andquality, could not endure.2)
The battle for the White House:
The GOP candidates want to evisceratethe Act, but even if one of them were to prevail in the general election, itwould take overwhelming agreement with a majority House Vote, WhiteHouse support and 67 votes in the Senate, to abolish a law already on thebooks. Don’t expect the 2012 election to be an upset for the AffordableCare Act. The likely GOP nominee, Mitt Romney, also advocated for anindividual responsibility requirement previously and passed similar healthcare legislation in Massachusetts. Reversing bans on lifetime limits,
discrimination against those with preexisting conditions, reducedmedication costs, free preventative care, and better quality, already ineffect for millions of Americans will not be popular, or easy. Americansknow that the quality of their lives depends on the quality of their healthand they won’t be keen on losing it.4)
3) Oh, Florida!
Not much good news from the nation’s most unpopular governor, Rick Scott. Scott’s extreme response in Florida to block thereforms and the federal money provided for health care access are a bigpolitical risk. Florida isn’t accepting federal monies to ready itself for theexchanges, isn’t working on accountable care projects, isn’t working toexpand benefits through Medicaid, and is spending its resources in delayand legal actions against the government in order to preserve industryprofit at citizen expense. The consequence: Florida isn’t ready; its citizensaren’t covered; its healthcare future is in limbo. The federal government ispoised to step in to set up the insurance exchange for its residents andhas refused its request to allow Medicaid vendors to spend less money onhealth care. What other assaults will the governor cook up this year? Staytuned.
Better Access, Affordability and Quality
:Watch the numbers and follow the money! Hard trackers will report thenumbers of private sector health care jobs created, people insured, protectedand using preventive, acute and chronic services under the ACA. Goodbyelifetime limits and discrimination against those who with preexisting conditions!Expect more savings through quality and less tolerance for fraud, waste andabuse. Thirty-two health provider organizations will roll out innovative caredelivery programs (accountable care organizations), for Medicare enrollees withpayment based on quality of care outcomes. This year some seniors will getaccess to service in their home, and get rebates for medications when they fall into the donut hole. And the pharma and insurance industries starts foot some of the bill for research to find treatments that work, while getting capped on profit atthe expense of quality. Expect reports on the cost of premiums for states,employers, and individuals as the Health Care Exchanges rev up; what its like for people who need and use care, health care professionals who provide care, andhospitals and systems that support care; and payment based on effectiveness of care and patient oriented outcomes that matter, rather than on the volume of procedures and visits.Rome wasn’t built in a day, and neither will be the ACA. This is a big law with abig agenda for a great nation. Already, it is improving access; improving qualitythrough reduced waste fraud and abuse, paying for performance; better medical

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