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The New York Times/ - Politics, Sáb, 31 de Março de 2012
CLIPPING INTERNACIONAL (Supreme Court)
A Health Law at Risk Gives Insurers
Pause
As the Supreme Court considers the constitutionality
of the federal health care law, one option that had
seemed unthinkable to its designers and supporters
now seems at least possible: that the court could strike
down the entire law.
Although it would be folly to predict what the court will
conclude, policy experts, insurers, doctors and
legislators are now seriously contemplating the
repercussions of a complete change in course two
years after the nation began to put the law into place.
Their concerns were heightened after three days of
court arguments in which some justices expressed
skepticism about whether the full law could stand
without the individual mandate requiring almost
everyone to have insurance.
“Many of us did not get the bill we wanted, but I think
having to start over is worse than having to fix this,”
said Robert Laszewski, a health care industry
consultant and former insurance executive who
opposed the bill.
Others say, however, the last two years have made it
easier for Congress or the states to revisit the issue.
The effort was not a waste of time, said Christine
Pollack, vice president of government affairs at the
Retail Industry Leaders Association, a trade group that
represents large retailers and opposed the law. “There
has been an important dialogue that has happened
over the last three and a half years that has been a
long time coming,” she said.
The most ambitious provisions would be nearly
impossible to salvage, like the requirement that
insurers offer coverage even to those with existing
medical conditions and the broad expansion of the
Medicaid program for the poor. Popular pieces of the
legislation might survive in the market, like insuring
adult children up to age 26 through their parents’
policies, along with some of the broader changes
being made in the health care system in how hospitals
and doctors deliver care.
Abandoning the efforts and billions of dollars invested
since the law was passed in 2010 would result in
turmoil for hospitals, doctors, patients and insurers.
Many insurers would have difficulty changing course.
“The risk of repeal and starting from zero frightens
them infinitely more” than having to comply with the
law as written, said Michael A. Turpin, a former
insurance executive who is now a senior executive at
USI Insurance Services, a broker.
Maryland’s health secretary, Dr. Joshua M. Sharfstein,
said he was worried about the 50,000 people
nationwide who are enrolled in a federally financed
insurance program because they are seriously ill and
cannot find coverage otherwise. If the entire law is
thrown out, those people “don’t have other options,” he
said.
Numerous provisions in the law have already gone into
effect, like steps aimed at closing the coverage gap in
Medicare drug plans and some of the regulations
governing the profits of health insurers. The federal
government has also spent about three-quarters of a
billion dollars helping states set up new exchanges for
people to buy coverage in 2014 when the full law goes
into effect.
“The part I struggle with is how you undo two years
worth of implementation,” said Dr. Glen R. Stream,
president of the American Academy of Family
Physicians. “It would leave tremendous uncertainty
about what is the direction we’re going in and that
uncertainty would obviously affect the patients
directly.”
Health insurance companies, which would be freed
from some of the already existing regulations limiting
their profits, would have to readjust their thinking about
how best to compete. While companies would continue
to make money by carefully selecting which customers
to cover and would adjust their business accordingly,
many insurers say the health care market is deeply
flawed. “The system doesn’t work,” said Mark T.
Bertolini, the chief executive of Aetna. “Something has
to be done.”
The law, “while imperfect in a number of ways, was a
step forward,” Mr. Bertolini said.
If the law is overturned, some said Congress and the
states could act to restore some of the lesser-known
provisions. For example, the law reauthorized the
Indian Health Care Improvement Act, which finances
tribal health programs, allowed the Food and Drug
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