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Health care law verdict to be pivotal |

Health care law verdict to be pivotal

Some legal experts say it will be one of the biggest Supreme Court decisions in decades.

The nation’s highest court is expected to rule today on whether parts or all of the Patient Protection and Affordable Care Act — often referred to as “Obamacare” — is constitutional. The Supreme Court’s ruling on the controversial 2-year-old law could determine whether President Obama or GOP challenger Mitt Romney wins the general election.

The outcome will have dramatic implications for consumers, employers, insurers, hospitals and doctors, experts say.

“The controversy probably has more to do with partisan politics than the policy outcomes,” said Dana Goldman, professor of health policy and economics at the University of Southern California.

Fifty-six percent of people are against the health care law and 44 percent favor it, according to a Reuters/Ipsos poll last weekend.

Whether or not the court strikes an individual mandate requiring Americans to buy health insurance, health care experts agree the law has prompted the nation’s health care providers to cut costs and improve quality.

“The train has left the station, and it’s going pretty fast in a direction that we think is better for everybody,” said Diane Frndak, vice president of quality and safety at West Penn Allegheny Health System. Officials at the five-hospital network that includes Allegheny General and West Penn hospitals are working on several plans to cut costs as a result of elements in the law.

“There’s a recognition that we need to have systematic reform. That’s not going to stop,” Frndak said.

Even so, key elements of Obama’s health care overhaul hang in the balance. Shepherded through Congress by Democrats, the law was challenged in court by 26 states that argued that it infringed upon states’ rights and individual liberties.

David Taylor, executive director of the Pennsylvania Manufacturers’ Association, said the legislation is “an attack on our individual liberties.”

If the law is upheld, “government will be able to force us to do everything,” Taylor said at a campaign event for Romney.

The law calls for the establishment of online insurance marketplaces, known as an insurance exchange, that would allow individuals and small businesses to shop for affordable rates. As in all other states, the Pennsylvania exchange has been planned with grants from the U.S. Department of Health and Human Services. It is unclear if state officials would opt to pay for the exchange with state dollars.

A recent $33 million federal grant toward the Keystone state’s exchange has not been used as officials await the court’s decision.

Also at stake are elements of the law implemented before 2014: allowing young adults to remain insured until age 26 under their parents’ policies; prescription drug savings under the Medicare program; high-risk insurance pools for people with pre-existing conditions; and tax credits for small businesses.

Health experts said the ruling could have far-reaching repercussions depending on the outcome. Health insurers may not have to add millions of uninsured people to their rolls. Hospitals, meanwhile, could have to continue to treat uninsured patients unable to pay their bills.

The law calls for insuring 16 million more Americans by expanding the federal Medicaid program. It requires insurance companies to take all people, regardless of any pre-existing health conditions.

“The most likely scenario is striking the mandate and the protections for people with pre-existing illnesses,” said Robert Field, professor of law and health care policy at Drexel University. “My feeling is that it’s unlikely they will strike down the entire law. It’s possible that they would see this as an occasion to make a statement and to really try to rein in congressional and federal power. If that’s where this is going, I guess they could strike the entire law.”

The court could choose to toss out only the individual mandate to obtain health insurance. If that happens, Field said, leaving in a requirement for insurers to enroll people regardless of pre-existing conditions could be problematic. Insurers could face an onslaught of potential subscribers who are sick.

“If they just strike the mandate and nothing else, the big loser would be insurance companies who would have to provide policies but would not have healthy people to help spread the risk,” he said.

Regardless of what the ruling states, some insurance companies have responded by saying they would continue to offer some consumer protections mandated by the law.

Aetna, Humana and United Healthcare have said they will continue to offer an option to keep children up to the age of 26 on their parents’ policies. UPMC Health Plan likely will do the same, said Dr. Steven Shapiro, chief medical and scientific officer at UPMC.

Locally, the largest hospital systems have geared up for the law by setting up programs to eliminate disparities and address quality measures such as the number of readmissions. Medicare plans to penalize hospitals that have frequent readmissions for chronic conditions such as heart failure.

UPMC’s Shapiro said the region has been viewed as a national model for health care reform because once Highmark Inc. completes its $475 million acquisition of West Penn Allegheny, there will be competing organizations that are both payers and providers of care.

“It won’t make a difference whether the law is upheld or not,” Shapiro said. “We will go about developing new models of care to try to improve quality and decrease cost. We will have two competing integrated delivery systems, which leads to better care, lower costs. In a way, all the angst that we’ve undergone in Pittsburgh is really viewed as the epicenter of health care reform.”

Dr. Robert Keenan, vice president and chief quality officer for Allegheny General Hospital in the North Side and West Penn Hospital in Bloomfield, said the hospitals will continue to address problems such as higher-than-expected readmission rates, hospital-acquired infections and medical mistakes. The law carries several provisions addressing those areas.

“These are changes that needed to happen regardless of whether we had the Affordable Care Act or not,” Keenan said. “The changes are necessary because the way we are currently delivering health care is inefficient, inequitable, expensive, and that needs to change.”If the individual mandate is scratched, experts agree that one problem will remain: how to efficiently provide care for the uninsured, which by some estimates exceed more than 50 million Americans. Many of them show up in emergency rooms when they need care, instead of seeking preventive care that can be better coordinated by a primary care doctor, Frndak said.

“This is a societal problem that needs to be solved,” she said. “We are not providing care for a significant number of people who need care.”

Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or [email protected].

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