Today, the United States Supreme Court ruled that the full Affordable Care Act may continue. The Affordable Care Act is a landmark piece of legislation, and the Washington State Hospital Association supports it as a way to ensure all our residents have needed health care coverage and access to care.

“There are now more than a million people in Washington State without health insurance. As the people on the front lines who care for the uninsured in times of crisis, we know the tragedy that befalls those without health insurance. People without insurance have no access to regular care, are more likely to be very ill or disabled, take longer to recover from health care crises, and are more likely to die. This is unconscionable,” said Scott Bond, president of the Washington State Hospital Association.

The Affordable Care Act is a bold step forward to dramatically reduce the number of people without insurance. The pieces of the law fit together: the expansion of Medicaid to many low-income adults, the creation of the health insurance exchange, the subsidies within the exchange to help low-income and moderate-income families purchase coverage, and the individual mandate. Combined, these programs will provide hundreds of thousands more people in our state with health insurance.

“We are also pleased the law will go forward because hospitals have a huge financial stake in the health insurance expansions. The law contains enormous reductions in hospital payments - hospitals’ contribution to pay for the health insurance expansions. Over the next ten years, federal reductions in hospital payments are projected to be $155 billion nationwide, and $2.7 billion in Washington State alone,” continued Bond. “If the law works as intended, many more people who are currently uninsured will become insured. They will be able to get primary and specialty care, will not rely on the ER for their care, and when they are hospitalized the hospital will receive some payment. Hospitals that treat a high number of the poor and uninsured will not be as burdened; the special government payments that support them will be less critical.”

The prospect of abandoning the health care expansions but keeping the $2.7 billion in reductions was deeply troubling to Washington’s hospital leaders. This would have been destabilizing for hospitals and health care for all patients.

“The Supreme Court decision gives states the option to expand Medicaid coverage to very low-income adults. People who will be covered by this expansion are working at low-wage jobs but currently ineligible for Medicaid. The Washington State Hospital Association will strongly advocate for the Medicaid expansion in our state,” said Bond.

The United States Supreme Court decision is hugely significant. But many of the reforms embedded in the law are already underway, particularly at hospitals.

Hospitals will continue to improve care, focusing on increasing quality, creating efficiency across the continuum of care, and investing in health care information technology. Hospitals are also establishing and strengthening strategic partnerships or combining with other hospitals or other health care providers. These partnerships will lead to better coordinated care and allow the provision of care to people across a variety of settings for the full course of treatment.

Expectations to care for more people at a lower cost will continue. Through bundled payments and value-based purchasing, the law sets a goal of changing how hospitals are paid, shifting reimbursement from payment per service to payment per patient or per condition for the full course of treatment over a longer time period. This includes increasing the focus on prevention and better outcomes. Washington State hospitals welcome exploration of state-based or regional pilot or demonstration projects to chart a path to making this goal a reality.

Cassie Sauer

Vice Pres. Public Affairs

Wash. State Hospital Assoc.