After three months of deliberations, the Supreme Court, in what appears to be a carefully orchestrated alignment of divergent views and interpretations, delivered a decision that upholds the constitutionality of the requirement for individuals to obtain health insurance coverage (or pay a penalty “tax”), and of the expansion of the Medicaid program.
The ruling limits the ability of the federal government to withhold Medicaid funds from states that decline to participate in that expansion, holding that the federal government may properly withhold Medicaid funding for expansion of coverage from states that decline to participate in the expansion, but it cannot withhold funding for Medicaid programs that the state does agree to participate in.
If anyone in the industry still needed convincing that it’s time to get moving on healthcare reform, the Supreme Court ruling on June 28, 2012 has delivered the message. When the Patient Protection and Affordable Care Act (PPACA) was passed in 2010 the implementation deadlines were aggressive. Now, more than two years later, they are even more challenging.
There’s no shortage of work to be done to be ready for the major health insurance business reform implementation milestones that are looming in 2014, and almost all of it requires heavy-lifting technology to make it successful. Health insurance exchanges (HIX) that will facilitate eligibility verification and enrollment in subsidized health coverage programs, and act as online marketplaces for individuals and small employers to compare, shop and purchase coverage, must be designed, built, tested and deployed in every state – either by the state itself, or with the assistance of the federal HIX solution.
A parallel effort is taking shape in the private sector as well – as commercial and non-profit health plans and payers create new products and build processes and information technology systems to take advantage of the opportunity that the HIX offers as a sales channel for reaching individual and small group coverage customers.
The hospital and physician sectors will have their work cut out for them as well, as Medicare payment reforms like value-based purchasing and the MSSP Accountable Care Organizations come on line. For organizations already struggling with the mandates to demonstrate “meaningful use” of electronic health records and implement ICD-10 coding systems, these are formidable additional challenges.
Careful planning and flawless execution are the keys to success and the time for taking a “wait and see” position has passed.