SEP­A­RA­TION ANX­I­ETY

Providers fol­low of the re­form law anf moer for­ward while many staters use rulling to pull back for man­dates

Modern Healthcare - - Front Page -

Con­ser­va­tive state lead­ers de­clared open re­volt on the Pa­tient Pro­tec­tion and Af­ford­able Care Act last week af­ter a sweep­ing fed­eral court rul­ing out of Pen­sacola, Fla., that, if up­held on ap­peal, would in­val­i­date the en­tire law.

“There is no cur­rent plan to im­ple­ment Oba­macare,” said Brian Hughes, spokesman for newly elected Florida Gov. Rick Scott, a Repub­li­can and for­mer health­care ex­ec­u­tive who op­posed the re­form law long be­fore he took of­fice last month. “He hopes and be­lieves that it will con­tinue to be de­clared un­con­sti­tu­tional or it will be re­pealed.”

State of­fi­cials in Idaho, Utah and Wis­con­sin is­sued sim­i­lar re­form re­fusals last week, even though U.S. District Judge Roger Vin­son de­clined to is­sue an in­junc­tion block­ing im­ple­men­ta­tion of the law in light of his con­clu­sion.

When asked what Scott’s ad­vice would be to the state’s 210 com­mu­nity hos­pi­tals whose busi­ness the law is trans­form­ing, Hughes said the gover­nor would not be is­su­ing ad­vice to hos­pi­tals.

Le­gal ob­servers, in fact, dis­agreed sharply on ex­actly what Mon­day’s rul­ing even means, cre- at­ing un­cer­tainty for the health­care reg­u­la­tory en­vi­ron­ment. Days af­ter the rul­ing was is­sued, Vir­ginia of­fi­cials sought to fast-track a le­gal chal­lenge of the law to the U.S. Supreme Court.

How­ever states re­spond, hos­pi­tal ex­ec­u­tives said they would con­tinue push­ing for­ward. “If the law stands, the im­ple­men­ta­tion dates will stand,” said Richard Mor­ri­son, re­gional vice pres­i­dent of govern­ment and pub­lic af­fairs of the 20-hos­pi­tal Florida Di­vi­sion of Ad­ven­tist Health Sys­tem. “If you’re plan­ning for it to be over­turned, but it isn’t, you’re go­ing to have a hard time in the new en­vi­ron­ment in 2014.”

That’s when many of the re­form law’s goals be­come laws, such as set­ting up state-based in­surance ex­changes, pro­mot­ing the ex­pan­sion of state Med­i­caid pro­grams and re­quir­ing pri­vate cit­i­zens to buy fed­er­ally ap­proved health­care in­surance plans, among many oth­ers.

In a 78-page opin­ion is­sued Jan. 31, Vin­son de­clared the health­care re­form law void, rul­ing that its man­date for in­di­vid­u­als to buy in­surance over­stepped Congress’ power to reg­u­late in­ter­state com­merce and that the man­date could not be sev­ered from the broader leg­is­la­tion

Though it was the fourth such rul­ing from a district court judge, and the sec­ond to find in­di­vid­ual man­date in the law un­con­sti­tu­tional, the Pen­sacola case was the most closely watched na­tion­ally be­cause it fea­tured 26 states as plain­tiffs and dozens of leg­is­la­tors and in­ter­est groups join­ing with their own friend-of-the-court briefs.

And Vin­son was the first to judge the leg­is­la­tion fa­tally flawed. He wrote that the com­plex law was like “a finely crafted watch” and that re­mov­ing spe­cific pro­vi­sions would have un­fore­seen con­se­quences. In con­trast, U.S. District Judge Henry Hud­son in Rich­mond, Va., like­wise found the man­date un­con­sti­tu­tional but also that the law could stand with­out it, writ­ing in a rul­ing is­sued Dec. 13.

Vin­son made clear that he viewed the le­gal fight not as a bat­tle over health­care ac­cess, but rather the ten­dency of govern­ment pow­ers to ex­pand be­yond legally con­scripted bounds un­less kept in check by the courts.

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