Supreme Court Upholds the PPACA

In a surprising ruling, the Supreme Court upheld the constitutionality of the PPACA, in its entirety.  Earlier in the week I wrote that my view, substantiated via conversations with many insiders ranging from lawyers to professors to think-tank analysts, was that the Court would find the core of the law unconstitutional.  My guess is that many people today who were of the same opinion are saying “whoops – missed it by a mile”.

As I wrote earlier, my advice to providers and clients alike has been to “stay the course” in terms of their PPACA preparations.  Why?  As I indicated, regardless of the outcome of the Supreme Court’s decision, fundamental change has already occurred during the first phases of PPACA implementation.  The life or death of the PPACA would not directly change the landscape “as is” and given CMS’ regulatory power, administrative law would certainly come forth codifying many current provisions such as ACOs, bundled payments and pay for quality.

Where and how today’s future shapes the next six to nine months of health policy in this country is for me, the most fascinating element.  Politically, the war is just starting and we’ll see at least the first part of this multi-act play conclude in November.  Here are a few current fall-out issues that deserve watching.

• The Funding/Fiscal Debate:  By various estimates, some arguably more reliable than others, the PPACA will cost at least $1 trillion to fully implement.  Estimates correlated to its demise suggest that a world without the PPACA would see reduced deficits of $280 plus billion over a ten-year span.
• States and the Implementation of Exchanges: There are multiple states that have balked at developing their own exchanges and using the latitude provided by the Feds to formulate their own plans, assuming the PPACA would die via the Supreme Court.  These states that delayed their exchange developments are facing today, no flexibility via way of the law’s mandates – they will get a mandated exchange plan from Washington.
• The Economic Reaction: There are a myriad of economic issues that this decision will trend both positively and negatively.  Here’s my top list to watch.
  • The investment markets.
  • Small business reaction and in-turn, employment.
  • The healthcare economy, particularly the reactions in stock movement for large pharma and for-profit hospital providers.
  • Physician reactions – this group as a whole is a very powerful and savvy political group.
  • Union reactions – a bolstered group by this decision allows unions to potentially gain traction going into November after a series of stinging electoral defeats for their candidates, most recently in Wisconsin.
  • Election polls – where will this decision trend?  For Obama? For Romney? Neither?

I will assuredly read the decision and continue to keep track of how it plays out in the upcoming weeks and months.  Likewise, I’ll offer insight and commentary on what I see and hear as I feel the same is relevant.