Thursday, July 5, 2012

Next steps for the ACA

Hope everyone had a great 4th! Also thankful to have the power back on...

Before heading out for the night, I wanted to opine on some post-SCOTUS-ruling thoughts:

A lot the recent news cycle has shifted from the individual mandate to the the court's ruling on Medicaid. Officially, the courts have ruled that the federal government does not have the right to withdraw funds from states for refusing to comply with the expansion. So now the ball is in the Governors' courts for deciding to expand their Medicaid program - in which the federal government would flip the bill (for 3 years, I believe).

This, actually, came as kind of a surprise.

In the decision, that provision of the law was likened to "holding a gun" to the heads of the states. But - isn't that how all federal programs work? Congress or the bureaucracy creates programs and says that the states must fallow X guidelines in order to receive funding, and changes are made to the program that the

My father actually likened it to road funding. When the federal government funded road construction for the states - they said they had to set certain speed limits. Those requirements have changed over time, and the states have had to comply with them in order to receive their funding. I haven't delved into this issue too much - but there must be another Supreme Court case where this issue has come up...

Anyway - back to the policy talk.

As I said, many governor's (i.e. Republicans) are saying that they will simply turn down the funds and not expand their medicaid programs. This raises a point about the health care bill that has largely been left out of the discussion for some time: How does the bill reduce costs other than through increasing coverage (i.e. through the mandate and medicaid expansion)?

I think this is part of the discussion that Obama should be focusing on when talking about health care - because it gets left out a lot of current debates. Though the conversation among policy wonks seems to be shifting. (See here and here.)

Another key provision of the ACA is the establishment of Accountable Care Organizations (ACO).

I'll write about some of the specifics later - but the general idea is pretty simple. Accountable Care Organizations can consist of health care providers, physicians, and hospitals to better coordinate care for patients.

Two things drive the goals of these organizations: efficiency and low cost of care. They work to provide the most effective treatments at the lowest cost. And what's really great about it - is that it's primarily private-sector driven. I'd love to see how conservatives feel about it if this provision of the bill ever comes to the national spotlight.

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