Health reform survives

In a complex decision, a slim majority of the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). The Justices ruled that the individual mandate is a legal tax, that Congress has the power to impose taxes, and that individuals can decide to pay the tax and not purchase health insurance.

The Medicaid provision was narrowed to limit the power of the federal government to terminate funds to state Medicaid programs. States that fail to expand program eligibility as required by the new law would lose only additional funding, not all federal support for Medicaid programs.

Academy of Managed Care Pharmacy (AMCP) CEO Edith A. Rosato, RPh, IOM, weighed in with comments following the Supreme Court’s ruling. “The Supreme Court’s decision to uphold the individual mandate has removed a great uncertainty in the healthcare marketplace,” Rosato said in a prepared statement. “There are many provisions in the reform package through which managed care pharmacy can help achieve positive health outcomes for patients and assist in controlling escalating costs of healthcare in the United States. These include developing a pathway to bring follow-on biological treatments to market and using scientific research to evaluate outcomes of various treatment options. The Academy is dedicated to improving health and well-being of millions of Americans through sound medication management.”

Newly elected member of AMCP Board of Directors David Calabrese, RPh, MHP, said that the Supreme Court's decision to uphold the individual mandate as a tax helps to preserve the original goals of reform – to expand coverage, eliminate waste, improve coordination, and drive quality and efficiency within the nation's healthcare system. “In order to achieve these ambitious goals, however, much work remains to develop and refine the appropriate infrastructure to support these efforts,” said Calabrese, who is also clinical editor of Formulary and vice president, clinical operations, Med Metrics Health Partners, an SXC Company.

The impact of the Supreme Court decision as it pertains to theACA has to balance the well-being of the individual, community, nation, and the interests of various stakeholders involved in the healthcare process, according to Formulary advisor David G. Fuentes, PharmD, BCPP, CGP.

“There is no easy remedy to this situation and healthcare providers will have to be resourceful in continuing to treat a population of patients with varying perspectives on healthcare needs, health belief models, and readiness to incorporate care into their lives,” said Dr Fuentes, associate professor, clinical and administrative sciences, Roosevelt University, College of Pharmacy, Shaumburg, Ill. “The impact of this Supreme Court's decision upholding the ACA balances freedoms on many levels with the potential responsibilities of perhaps having to care for more severely- and acutely-ill patients should many not have a form of ongoing connection and relationship with a healthcare system and providers.”

It will be interesting to see how this ruling will have an impact on the day-to-day care of patients and the novel situations it may bring to the forefront of healthcare and societal relationships between the government and individual consumers and providers of healthcare services, Dr Fuentes added.

According to SCOTUSblog, the Supreme Court of the United States blog, sponsored by Bloomberg Law, “Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.”

“The states’ right to continue in Medicaid . . . is a huge counterbalance,” F. Randy Vogenberg, PhD, RPh, Institute for Integrated Healthcare and cofounder, Bentelligence, told Formulary.

Formulary advisor James M. Wooten, PharmD, associate professor, department of medicine, University of Missouri-Kansas City School of Medicine, believes that it remains a mystery about how states are going to pay for this.

“The [ACA] essentially made it easier for people to get Medicaid from a state,” Dr Wooten said. “With more people on Medicaid, the state’s healthcare costs will skyrocket. The original law stated that the states would pay for it or the federal government would penalize them if the state failed to do so. The Supreme Court stated that this was unconstitutional. How does this get paid for now? As usual, the ‘devil is in the details’ and this now raises more questions than answers. I am not sure exactly where this is headed.”