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Five Unanswered Questions About Health Reform

Now that the days awaiting the Supreme Court’s initial decision on the Affordable Care Act (ACA) are long over, we wanted to take time to remind everyone about the many unanswered questions which remain.

  • Will all the states now move forward to implement insurance exchanges?
  • Will some states refuse to expand Medicaid coverage?
  • Will most individuals opt to pay the modest “tax” and forego purchasing more costly health insurance?
  • Will other aspects of the law (e.g., the Independent Payment Advisory Board, or IPAB) be found unconstitutional in subsequent litigation?
  • Will the political fallout from this decision influence the upcoming national elections one way or the other?

One thing is certain:  the Supreme Court’s ruling on this case is far from the last word on healthcare reform and the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) will continue to seek repeal of certain aspects of the ACA that are onerous to the practice of medicine and that are detrimental to patients’ access to quality care.  Provisions in the law, such as the IPAB, Physician Quality Reporting System (PQRS) and the Value Based Payment Modifier, only seek to further penalize healthcare providers without doing anything to improve patient care.  Additionally, neurosurgery will continue our efforts to repeal Medicare’s flawed sustainable growth rate (SGR) formula and to pass medical liability reform—two critical aspects of health reform that were not addressed in the ACA.

And, of course, we would be remiss not to point out that the upcoming elections in November will play a “little role” in the next chapter of healthcare reform.  Add to these questions, the whole Budget Control Act aka “ budget sequester,” which imposes caps on all discretionary spending and billions in cuts in Medicare spending (a topic we’ll address in more detail on Thursday’s post), and uncertainty about our nation’s healthcare programs will remain.  One doesn’t need a fortuneteller to see the healthcare landscape — or should we say cliff — but we won’t go there because we’re pretty sure you are already having a manic Monday.

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