Will Healthcare Reform Survive Debt Ceiling Legislation?

Contrary to media headlines closely monitoring the lower- and mid-level federal courts as they opine on the individual insurance mandate, the United States Judiciary Branch may have little impact on the future of President Barack Obama's 2010 Patient Protection and Affordable Care Act. As fascinating as the legal ramifications may be, the ways in which the Commerce Clause or the Necessary and Proper Clause impact the constitutionality of healthcare reform's most notorious provision of late could have little meaning if the government fails to pay a few utility bills and the congressional lights go dark.

While the importance of judiciary participation in this historical debate should not be discounted, the U.S. healthcare system must first and foremost be concerned with self-sustainability, especially in light of recent issues concerning our credit rating as a nation. Unfortunately, such a series of events has had the misfortune to manifest itself just as the PPACA proposes to alter the foundation of modern American healthcare. In fact, according to Congressional Budget Office estimates, major health programs accounted for 2.9 percent of the nation's GDP between 1971 and 2010 (averaged). Under the PPACA, this figure may increase to as much as 7.1 percent by 2021.

Since the PPACA was first passed in 2010, critics of the 2,700-page legislation have successfully focused the nation's attention on items such as accountable care organizations, the Independent Payment Advisory Board, a tax hike on tanning salons and the individual insurance mandate. The PPACA also forms the cornerstone of a dramatic and fundamental shift in the way CMS will approach hospital reimbursement in the future, recalibrating its infrastructure to focus primarily on performance rather than cost. Together, these concepts are a few examples of the philosophy behind the dramatic push to reduce healthcare spending in America.

Notwithstanding the importance of these programs, no single example touches upon the true crux of healthcare reform, and such cost-saving measures account for only a small part of the 2010 landmark legislation. In effect, the PPACA is primarily a collection of pilot programs, preventative healthcare services and forward thinking research, much of which escapes the media spotlight. This includes the Patient-Centered Outcomes Research Institute, created by the PPACA to produce groundbreaking, evidence-based information pertaining to healthcare that will be easily accessible by both doctors and patients. It also includes the National Prevention, Health Promotion, and Public Health Council, established by Executive Order on June 10, 2010 and designed in part to promote "transformative models of prevention, integrative health, and public health" nationwide. And through a report issued by the PPACA's Prevention and Public Health Fund, the federal government estimates that a $10 per person investment each year in community-based, preventative health programs could result in an annual savings of more than $15 billion over the next five years.

Beginning in 2014, there is even a provision for employers to use a portion of their employees' health insurance premiums toward wellness programs in return for offering a variety of different outcome-related incentives. PPACA also requires new health insurance plans to cover previously unaddressed preventative care, the most recent of which focuses on access to such services for women. The dozens of other preventative care areas — from abdominal aortic aneurysm in adults to 14 different vaccinations for children — represent more of PPACA's bold and meaningful focus on the future. In theory if not in practice, the PPACA attempts to provide a financial mechanism to ensure that no preventative stone is left unturned, highlighting one of the program's central tenets that is often overlooked.

Whether or not you agree with these concepts fundamentally, it is difficult to argue that such an investment in the future of American health is anything less than laudable. Still, the question remains: what happens if we as a country cannot afford to foot such a bill? Although debt ceiling legislation has yet to impact Medicare and Medicaid, their combined future remains uncertain in today's tumultuous healthcare climate. As providers prepare for an overhaul of both systems, any additional reductions in payment due to a redirection of funds caused by the country's current deficit may devastate them, not to mention every other program under the umbrella of healthcare reform that requires funding of any sort.

Should this occur, the unprecedented healthcare legislation that continues to make headlines every day as it marches toward the doors of the United States Supreme Court may not survive that first Monday in Oct. 2012, and we may then be left with little more than a humble body of legislation consisting perhaps only of family coverage up until the age of 26, the necessary but not terribly progressive elimination of preexisting conditions, and a modest increase in competition within the individual state insurance markets.

PPACA's focus on preventative services, wellness programs and pilot studies may remain hidden for the most part, but they find themselves in the crosshairs as Congress tries to repair America's global credit score. Although these programs stand as a testament to the beliefs of our modern society, without the ability to provide for financing, their future is tenuous as the United States government may soon be forced to abandon the very foundation upon which healthcare reform is based. If debt ceiling legislation does prove to be PPACA's undoing, the mighty healthcare revolution that swept the country in 2010 may someday be little more than a footnote detailing another failed attempt at universal coverage. There is nothing humble about that.

Mr. Garner is an attorney and healthcare consultant, specializing in issues surrounding modern American healthcare and the ways it should be managed in its current climate of reform. Between 2002 and 2011, he was the CEO at Coast Plaza Hospital in Norwalk, Calif. In Jan. 2012, he will offer a hospital law course at Pepperdine University School of Law in Malibu, Calif.

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