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The next four years for health care

The next president of the United States is Barack Obama. The Republicans have retained control of the House of Representatives, but not the Senate.

What does this mean for health care?

We know that the president intends to pursue implementation of the Patient Protection and Affordable Care Act. Here are answers to some of the other questions that have arisen around these elections:

Romney promised to repeal the health care reform law. Can that still happen?

Almost certainly not. Only Congress has the power to repeal laws. And while the House under Republican control could vote to repeal the law, the Senate would be unlikely to support repeal since Republicans are not projected to take control through winning more seats. Even if there were enough votes in the Senate, President Obama would veto an attempt to repeal the law.

If the law is not repealed, what will happen?

The most significant changes will occur in the beginning of 2014. At that time, health insurance exchanges must be in place (you can check past posts on my blog to understand this issue). If states do not put an insurance exchange in place, the federal government will.

The requirement for employers with more than 50 employees to provide insurance coverage for their employees or pay a penalty will go into effect in January of 2014. In addition, 2014 is the first tax year that individuals will pay a tax penalty if they do not have insurance.

The provision of the law requiring states to expand their Medicaid programs or lose their Medicaid funding has already been overruled as unconstitutional by the Supreme Court. For those states that decide to expand their Medicaid programs to obtain federal funds to cover the expansion costs for the first three years, the first year of expansion funding occurs in 2014.

Finally, there is a continued phasing out of annual and lifetime limits of coverage under insurance.

We don’t know yet whether the Idaho Legislature will approve a state-run insurance exchange and Medicaid expansion.

What happens in 2013 under the health care reform law?

The law provides for increased funding to state Medicaid programs that choose to provide certain preventive services at little or no cost to beneficiaries; for two years, primary care physicians will receive the same reimbursement for primary care services provided to Medicaid patients as they do for Medicare patients; and states will receive additional funding for the Children’s Health Insurance Program.

Will the health care reform law curb out-of-control health care spending?

Most experts do not expect that health care spending will be remedied by the health care reform law. The law did much to address issues of coverage and certain insurance abuses, but did little to control overall health care costs.

Given the federal deficit, the fiscal cliff, and one downgrade of U.S. debt and another downgrade threatened, what can we expect the re-elected president and the newly elected Congress to do?

Unless political gridlock can be overcome, 2 percent across-the-board spending cuts are scheduled to begin in January. This will mean 2 percent reductions in reimbursement to hospitals and health care providers. And given that nearly half of all hospitals are operating in the red, we can anticipate much more consolidation in the hospital market across the country and possible hospital closures.

A repeal of the Sustainable Growth Rate formula, which would result in nearly a 30 percent cut in the Medicare physician fee schedule, is unlikely. We would expect that the threatened pay cuts will be postponed again.

The good news is that St. Luke’s strategy of accountable care, which is our Triple Aim – better health, better care, and lower cost – prepares us well for the continued implementation of health care reform under President Obama.

However, if we merely comply with the law, we will not fix what is wrong with health care, nor make care more affordable for those in Idaho. That is why we are not merely complying with the law, but transforming health care through innovation. We were leading the way prior to this election and we will continue.


David C. Pate, M.D., J.D., is president and CEO of St. Luke’s Health System, based in Boise. Dr. Pate joined the system in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center. This article was originally published on his blog, Dr. Pate’s Prescription for Change.

About David C. Pate