The Supreme Court’s ACA Ruling: One Year Later

June 28, 2013
We’re one year removed from the historic ruling by the Supreme Court, upholding President Obama’s signature domestic legislation, the Patient Protection and Affordable Care Act. While a lot has changed in the year since then, it’s clear that a lot of work is still ahead of us.

As anyone who went to journalism school can probably attest, you live for days like June 28, 2012. You live for history in the making.

If you can recall, June 28, 2012, one year ago from today, was when the Supreme Court voted to uphold President Obama’s landmark legislation, the Patient Protection and Affordable Care Act (ACA). Coverage of the Supreme Court’s decision of the Defensive of Marriage Act (DOMA) this week brought back some fond memories for me.

The Supreme Court’s ruling that day meant that the biggest change to healthcare policy since the 1960s wasn’t going anywhere: it was here to stay.

When HCI talked with various leaders in healthcare across the country, the message they essentially relayed to us was, “It’s time to move forward.” In fact, I recall David Classen, M.D., associate professor of medicine at University of Utah, and chief medical informatics officer at Pascal Metrics in Washington, D.C., basically saying that there was no turning back from this point on.

If the reality of the Affordable Care Act hadn’t yet set in for healthcare leaders on that day, it has by now. In a few short months, some of the largest parts of the ACA will be enacted. By then, there will be open enrollment in a health insurance plan through the law. Recently, the Department of Health and Human Services (HHS) launched a new version of, to try to educate Americans on how they can shop for health insurance using the new marketplaces. By next year, most Americans will be penalized if they aren’t insured.

The ACA has always been less central to healthcare IT leaders work than the Health Information Technology for Economical and Clinical Act (HITECH) and its meaningful use mandates. However, we’ve seen leaders of IT continuously prepare for various aspects where healthcare information systems will be necessary: the mandatory value-based purchasing, healthcare-acquired conditions reduction, and readmissions reduction facets of the law (set to rise to 2 percent next year, 3 percent of reimbursement in 2015), and the voluntary Accountable Care Organizations (ACOs) and bundled-payments initiatives.

Yet as the reality of the law sets into place, the meat of it remains as controversial to some Americans. A recent poll conducted by Gallup found that 22 percent of Americans feel the law will make their family’s healthcare situation better, 42 percent say it will make their situation worse. Thirty-three percent said it will have no effect. Although, that poll proved the dividing line is still very much political, 89 percent of Republicans disapprove of the ACA, while 76 percent of Democrats approve.

It’s not just the public either. Railing against and denying use of the insurance marketplace and the Medicaid expansion have been platforms for Republican government officials, even after President Obama won reelection in November.

One thing that has struck me about the law is how little people know about it, even a year after it was made constitutional. We’re months away from the biggest chunks of the ACA being put into place and it’s still as complex to the public as ever. The Gallup poll revealed that even the most basic of provisions remain mysterious to some people, including the people who need to know the most! (The uninsured in case you were curious)

If you think I’m exaggerating then you must have missed the part where President Obama recruited Hollywood actors to promote the ACA. Would he be doing that if he thought people understood the law and its provisions?

The law is a reality and much has been done to prepare us for what lies ahead.  However, whether it’s implementation of policies, building IT infrastructure, overcoming political bickering, or even grasping a basic understanding of the law, it’s clear that the challenges related to the Affordable Care Act are still very much in front of us—just like they were on that historic day.

Therefore, it’s up to healthcare leaders, from hospitals, medical groups, payers, advocacy groups, and wherever, to educate their patient population on the effects of this law.

Thoughts? Feel free to leave comments below or respond to me on Twitter by following me at @HCI_GPerna.

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