Supreme Court ACA Decision: Implications for Medical Schools and Academic Medical Centers

Reaction to the U.S. Supreme Court ruling concerning the Affordable Care Act has been swift. The high court’s ruling to largely uphold the Patient Protection and Affordable Care Act has significant implications for patients, medical schools and academic medical centers.

The Affordable Care Act was deemed constitutional by the Supreme Court. What will that decision mean for patients and doctors?

Here is a sampling of thoughts about the decision from those affiliated with Albert Einstein College of Medicine,  Montefiore Medical Center, the University Hospital for Einstein, and the Association of American Medical Colleges.

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“The AAMC is extremely pleased that the Supreme Court has upheld virtually all of the Affordable Care Act (ACA).  This law is an important step toward an improved healthcare system that gives all Americans access to the care they need when they need it. However, we are closely examining the court’s ruling as it relates to the Medicaid expansion.

America’s medical schools and teaching hospitals are committed to improving the nation’s healthcare and have been leading the transformation of healthcare delivery through innovations in medical education, clinical care, and research. The court’s decision to uphold the ACA allows the important work of the Center for Medicare and Medicaid Innovation (CMMI), the Patient-Centered Outcomes Research Institute (PCORI), and the programs supported by the Prevention and Public Health Fund to continue.

With 32 million newly insured Americans entering the healthcare system, addressing the nation’s physician shortage—projected to climb to more than 90,000 by 2020—is now more critical than ever. Medical schools have done their part, increasing enrollments during the last six years in response to these shortage projections. But the overall supply of U.S. physicians cannot expand unless Congress increases the number of federally funded residency training positions, a number that has been frozen since 1997.

We urge Congress to move quickly to provide more federal support for additional doctor training to ensure that Americans have access to care—not just an insurance card.”

Darrell G. Kirch, M.D.
President and CEO, AAMC (Association of American Medical Colleges)

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“Today’s supreme court decision means that our students will enter a more equitable healthcare environment with greater access for all Americans. Now we need to address the urgent need for increased affordability without compromising quality. Our own University Hospital, Montefiore, proves this is an achievable goal.”

Allen Spiegel, M.D.
The Marilyn and Stanley M. Katz Dean, Albert Einstein College of Medicine

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“Healthcare is a human right, not a privilege.  The Montefiore model which we have created in partnership with Einstein, is the model for healthcare of the future.  The ACA provides us the tools to expand our paradigm and build a more effective system for not only our patients but as a model for communities across the nation.  The Bronx is smiling at this watershed moment.”

Steven Safyer, M.D.
President and CEO, Montefiore Medical Center

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The debate about healthcare all along was less about providing the best of care to our citizens and more about politics. Many people in this country are just unwilling to spend the extra $250 per year in increased personal taxes to underwrite the 30 million uninsured folks who need it. Anyone with a relative with a previous condition or who lost a job and remained without healthcare understood how much this law crystallizes the central principles of the United States. We can’t have liberty and justice for all if we can’t afford to live.

Edward R. Burns, M.D.
Executive Dean, Albert Einstein College of Medicine

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“Today, ACA jumped over a major political hurdle; now its ability to produce effective changes in healthcare can be tested.  Despite the imperfections of the healthcare reform law (ACA), it felt as though we had made a little progress when it finally passed in its much-compromised incarnation several years ago.

Remember the “surprising” data that emerged during the debate showing the vast differences in the cost and quality of care in various parts of the country? ACA was aimed not only at providing broader coverage and containing unsustainable healthcare costs, but is also designed to create “systemic” quality improvement through implementation of research evidence.”

Harry Shamoon M.D.
Associate Dean for Clinical and Translational Research
Professor of Medicine,  Albert Einstein College of Medicine

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“SCOTUS gets it right, with the extra surprise of Roberts as swing vote! Listen, the ACA disappointed a lot of us who were hoping for significant and substantial reform to our dysfunctional healthcare system, but at least it’s a start, and now the work can proceed. One of the most important and under-appreciated aspects of the law is the establishment of PCORI (http://www.pcori.org/), which creates an opportunity to do meaningful research to figure out which interventions lead to real improvements in both clinical outcomes and public health.”

Paul R. Marantz, M.D., M.P.H.
Associate Dean for Clinical Research Education and Professor
Director, Center for Public Health Sciences, Albert Einstein College of Medicine

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“Hooray! This is a landmark event – we now begin to join the community of civilized nations that provide means to get healthcare for everyone. But it is a first step – now we must ensure doctors get reasonable, fair and timely reimbursements so they will accept insurance and we must curtail the waste represented by insurance expenditures for administrative costs. To compare apples to apples. Consider Medicare public plan versus Medicare Advantage private plans; it is estimated that public plan costs are less than 2 percent of expenditures, compared with approximately 11 percent of expenditures by private plans.   The administrative costs of non-Medicare private plans are even higher – perhaps as high as 33%. Health insurance should be not-for-profit, just as public education is.”

Sylvia Wassertheil-Smoller, Ph.D, F.A.H.A.
Professor, Department of Epidemiology & Population Health, Albert Einstein College of Medicine

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DISCUSSION: What do you think about the Supreme Court ruling? Leave a comment below.

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The Doctor's Tablet Editors

The Doctor's Tablet Editors

The Doctor’s Tablet is co-edited by Paul Moniz and David Flores of Albert Einstein College of Medicine’s department of communications and public affairs.

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  • Simon Spivack, MD, MPH June 29, 2012, 8:32 PM

    This is terrific news, sobering in how slim the majority and how fragile the initiative, but nonetheless a strong impetus to medically cover all lives, as a basic human right.

    But there is a risk of complacency, as my understanding is that cost control and capitation are largely independent processes from the passage of this ACA bill.

    Our costs are roughly double what they should be. What drives excess health care costs are myriad, but the main factors that occur to me and others include: (i) Expectations of “all available resources applied”, reinforced by the cultural imperative in America of no limits, and the fears of peer review and plaintiff’s lawyers; (ii) A technological imperative, as diagnostics and interventions get proportionately more elaborate, and our medical tool box expands; (iii) Disproportionately rewarded procedural care in surgical and radiologic suites and intensive care units, a quirck of prior lobbying by certain medical/surgical/radiologic specialties that goes back 50 years; (iv) A perverse set of relatively under-regulated fee-for-service incentives, with neither of those two stakeholders (patient and MD) who are making the medical decisions having much reason to forego tests/procedures/extraordinary care, and some very potent considerations [(i), (ii), (iii)] to pursue them. (v) Finally, prevention research, and medical effectiveness and outcomes research, have been historically terribly underfunded. This has resulted in the state where most things we do in medicine still go un-examined, as the resources and human capital are simply unavailable to do so. Here’s where the academic medical center can uniquely contribute, and I think our combined strengths at Einstein/Montefiore are compelling to help lead the way, given our expertise in operating in a lower resource context, as articulated by Drs. Speigel, Safyer, Marantz, Shamoon.

    Simon Spivack, M.D., M.P.H.
    Professor and Chief, Division of Pulmonary Medicine , Department of Medicine

    Reply
  • Jon M. Hardy July 9, 2012, 7:19 PM

    How self-serving! This is like asking a dairy farmer how much he likes a statute that provides for milk subsidies and enforcement provisions to require everyone to purchase milk.

    Reply

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