Reaction to the Supreme Court Ruling on Affordable Care Act

CMS and ISMS: journey to reform far from over

“IT IS GOOD NEWS that Illinoisans will have the responsibility and tools for obtaining health insurance coverage. And it is also positive to note the important coverage provisions, such as the protection against denial for pre-existing conditions, which remain in place,” Illinois State Medical Society President William N. Werner, MD, stated in response to the U.S. Supreme Court’s decision upholding the Affordable Care Act on June 28.

“However, much work remains to be done before we can truly call our health system “reformed,” he added.

The Chicago Medical Society, which collaborates with the Illinois State Medical Society to enact improvements in the nation’s health system, issued its own statement.

“Our organization has long supported incremental approaches to health reform that expand access to medical benefits to all Americans through a public and private coverage system,” CMS President Howard Axe, MD, commented.

“We support reform that enhances the doctor-patient relationship; permanently fixes the broken Medicare payment system, known as the SGR; ensures professional liability safeguards such as caps on non-economic damages,” he continued.

“The Chicago Medical Society will continue working with ISMS to address our shared concerns.”

As outlined by Dr. Werner, significant challenges remain. The following is a summary:

Medicare Payment Reform
Our Medicare program’s financial health edges closer to a cliff each day Congress fails to enact reform. Currently, physicians face an across-the-board reimbursement cut of about 30% on Jan. 1, 2013. Without Medicare payment reform, our Medicare patients’ access to care is in peril.

Medicaid Reform
The Act builds coverage through significant Medicaid expansion. This is not a sensible policy in states such as Illinois with struggling Medicaid programs. Patients already receiving care through Medicaid face hurdles that those with other forms of insurance do not. Illinois’ current Medicaid reimbursement levels rank behind 40 states when compared to the Medicare fee schedule. The ACA provides for a temporary and limited Medicaid reimbursement increase, but more must be done to fix this program.

Medical Liability Reform
Despite a dire need for reform, Illinois courts have struck down strong medical liability protections here on more than one occasion. Federal reform is needed to help Illinois with our medical workforce recruiting.

Currently, half of the physicians who train here leave after residency. Two-thirds of those who depart cite our liability climate among their chief reasons for leaving. National physician supply projections suggest we will soon have an inadequate number of doctors to meet the needs of our patients. Illinois needs medical liability reform as a component of a comprehensive policy to address our medical workforce needs.

Until we address these issues, our journey toward a sensible and cost-effective health care system is far from over. The following ISMS Health Care Reform Principles are designed to assist Congress in crossing the finish line with health reform. We urge them to roll up their sleeves and finish the job.

ISMS Health Principles
ISMS supports the following healthcare system reform principles summarized as follows:

• Healthcare delivery and finance system reform should use the current public-private system as a basis and focus on incremental evolutionary change.
• All patients should have access to a health benefit plan that would include catastrophic coverage as well as preventive services, appropriate screening, primary care, immunizations, and prescription drug coverage.
• Health insurance reform is needed to allow public and private plans to develop innovative coverage plans, including the development of health savings accounts and other high deductible plans to encourage patients, physicians, and other health care providers to pursue high value care.
• All health care expenditures should receive equal treatment for purposes of tax deduction and tax credits.
• Professional liability reform—including caps on noneconomic damages­—should continue to be pursued and defended as a way to reduce direct and indirect costs (defensive medicine) and to address the adverse effect the current medical liability system has on the physician-patient relationship and access to health care.
• Use of information technology in healthcare delivery should be encouraged to improve quality and safety of care, enhance efficiency, and control costs.
• Healthcare education and literacy must be an important part of any medical care financing and delivery system reform.
• Healthcare reform proposals should include provisions for physicians to set and negotiate their own fees in order to adequately compensate physicians and other healthcare providers for the promotion of personal and public health.
• Evidence-based protocols should support, not replace the patient-physician relationship.
• ISMS objects to third-party insurance carriers interfering with the practice of medicine and the patient-physician relationship.

The ISMS Health Reform Principles can be read in full online at www.isms.org.