What If? Managing Uncertainty: The ACA and a Cure for Sleepless Nights

State of Reform is proud to launch, in collaboration with the Univ of Washington School of Public Health – Health Policy Center Initiative , a series titled “What If: A Post-Supreme Court World.”  This is the fourth piece in a series of contributions hosted on our news site, by a range of authors, about the possibilities for health care in a still hypothetical world after a Supreme Court decision.

We are managing uncertainty again. The Affordable Care Act – the health care law – is a complex, but needed, reform that provides the tools and momentum for us to get off our duffs and do the things we have been contemplating for the past 15-20 years. But, just as we get underway, the curve ball of the Supreme Court comes along, leaving us unsure. We can obsess about the barriers and uncertainties or we can focus on taking first steps that make sense and are needed.

Many of us manage uncertainty every day. Businessmen and women see an opportunity and know that they need to take a calculated risk and proceed before they can be certain that the venture will be successful.

In health reform, we can wait around for the Supreme Court decision and do nothing now – running the risk that when the Court and the political issues are settled we will have fallen further behind, lost our determination, and not be ready for the changes that we know we must make.

If we wait, we will not be able to take full advantage of the law – hurting our state and many of the residents who are getting pummeled by high costs for health care, exclusions for pre-existing conditions, stunted prevention programs, and limited access because insurance is not affordable. We should be held responsible for our actions – and in this case our possible in-action. We need to move forward with our thinking caps on and eyes wide open.

There are a number of elements of reform that require our immediate attention and action. We should get our health insurance exchange up and running – not wait for the federal government to implement the exchange program in the ACA. We need systems that wring out the waste we know we have in our current system; real marketplaces for small businesses and individuals that are not opaque and give us apples to apples comparisons; insurance rules that ban pre-existing condition exclusions and provide oversight over unwarranted rate increases; and most importantly, we need to improve outcomes for individuals and families living in our communities.

We need to speed up the changes in the health system that we know improve the quality of care provided, increase patient satisfaction, enhance physician and nurse satisfaction with their work, and save significant amounts of money. These are initiatives such as accountable care, primary care medical homes, chronic disease management, integrated care for vulnerable elderly, and community based prevention that helps our children live healthier lives.We have been stopped by the fear of being the first one to step forward. Doctors say: no one will pay for needed changes. Insurers say: we won’t pay for them until they can prove that their changes save us money. Patients say: make my care better and cost less – but they are fearful of change.

The mandate for health reform needs to be sorted out by the Supreme Court. Precedent says it should be found constitutional. But if the mandate is found beyond the scope of federal powers, we need to identify and implement the policy substitutes that ensure all people are in the insurance market.

Most importantly, we need to act now. We have been waiting for years for most of these changes and we can get started by responsibly addressing the needs of our communities and doing things that most people are certain need doing. The Affordable Care Act gives us some tools that we can – and must – use now.