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Election brings greater clarity over health-care reforms


Charlotte Business Journal by Jennifer Thomas.

Charlotte’s health-care providers may finally get some answers about the future of health-care reform now that President Barack Obama has been re-elected.

It has been more than two years since the Affordable Care Act was signed into law. But much of that time has been spent in a bitter battle over its legality and promises by GOP presidential candidate Mitt Romney and others to repeal the law.

The legislation is slated to expand health-insurance coverage to 32 million uninsured individuals through an expansion of state Medicaid programs and a requirement for most Americans to carry health insurance coverage. It also will make it possible for people with pre-existing medical conditions — many of whom couldn’t obtain coverage previously — to obtain insurance.

The Supreme Court upheld a key provision in June, ruling it constitutional to require most Americans to carry health insurance by 2014 or pay a penalty.

That left the election as the largest remaining hurdle.

“President Obama’s election victory will likely keep health-care reform on its path towards implementation, but many outstanding questions remain — Medicaid expansion and health benefits exchanges are just a few,” says Marci Wilding, director of government relations for Novant Health Inc.

The Winston-Salem-based health-care system is parent to Presbyterian Healthcare in Charlotte.

Novant remains hopeful that health care will not take a “disproportionate share of that burden” as the focus shifts to deficit reduction, Wilding says. She notes hospitals and other providers already have agreed to cuts as part of health-care reform.

Carolinas HealthCare System doesn’t expect the election to have a direct affect on its efforts to provide patients with access to high-quality care. Instead, the Charlotte-based health-care system remains focused on aspects of health-care delivery if can control, says Joe Piemont, president and chief operating officer.

“We are fully committed to the goal of defining our own future, and transforming health-care delivery, rather than simply waiting for the future to be imposed upon us,” Piemont says.

Carolinas HealthCare has implemented strategic initiatives in recent years to integrate clinical services, introduce new models of care and encourage patients to take a more active role in their health.

At Premier Inc., Senior Vice President of Public Affairs Blair Childs says, “I think that everything (related to the reform law) is just going to keep moving forward.”

Premier, a Charlotte-based health-care alliance, focuses on initiatives designed to improve the quality, safety and affordability of community health care. It represents more than 2,700 hospitals and health systems and 90,000 other health-care sites.

Childs doesn’t rule out delays in implementation of key provisions of the law such as expanding coverage. The government is facing a huge pressure to reduce the deficit and debt, including potential cuts to Medicaid and Medicare, he notes. Reform also calls for government subsidies for low- and middle-income individuals to offset the costs of purchasing health-care insurance.

Childs says one concern is that cuts to Medicare and Medicaid to control costs may adversely affect hospitals and other health-care providers by limiting their flexibility in reducing waste and inefficiencies. The legislation already includes $155 billion in cuts to Medicare payments to cover the costs of reform.

He cites another potential obstacle: Most states still need to establish health-insurance exchanges, through which consumers can purchase health-care insurance. And the federal government needs to put provisions in place for states that choose not to create those exchanges.

“That’s a lot to do in a year,” he says.

The election’s outcome confirms that CaroMont Health must continue to prepare for the challenges of health-care reform, says Randy Kelley, chief executive.

The Gastonia-based health-care system is parent to the 435-bed CaroMont Regional Medical Center.

“Regardless of what reform ends up looking like, we know we have a critical mission to uphold,” he says. “Our work is to save lives, and to change lives for the better.”

Kelley anticipates potential cuts to Medicare and Medicaid reimbursements as federal debt issues are addressed. That makes it critical for CaroMont to manage its margins to sustain the high-quality care it delivers, he adds. Those margins will face additional pressure as payment models for health care are transformed. Kelley expects payments will be tied to a patient’s overall health, with penalties for readmission to the hospital or avoidable hospital-acquired conditions.

“Health providers will be responsible for keeping people well,” he says.