Supreme Court: A Blow to HIT?

Will the coming June U.S. Supreme Court decision on the Patient Protection and Affordable Care Act (aka Obamacare), impact healthcare IT?

According to Janet Marchibroda, chair of the  Bipartisan Policy Center Health IT Initiative, health IT funding will not be reduced if the individual mandate is thrown out. If the Court rules the entire law unconstitutional, some HIT funds would be lost, but not the meaningful use incentives.

Marchibroda was formerly CEO of the eHealth Initiative and prior to that COO of the NCQA. She has been at the Bipartisan Policy Center since April 2011.

Speaking to the HIMSS Southern California Chapter on April 4, Marchibroda noted that it is impossible to predict exactly what the Court will do. However, many analysts believe the individual mandate will be ruled ineligible.

That would have little, if any, effect upon healthcare IT. The meaningful use incentive funds are part of the $36 billion HITECH Act, passed in 2009. If the Court tosses out the entire PPACA, some $10 billion in funding for pilot programs (e.g. pay for quality) to be allocated by CMS would be eliminated.

Marchibroda said that currently spending for healthcare IT enjoys bipartisan support, as most legislators continue to believe it will lead to lower costs and better quality.

She expressed concern about interoperability and said that healthcare vendors need to do a better job in that area. She warned that “Congress did not allocate $36 million to invest in building more silo” and predicted the issue would come up later this year if more oversight hearings are held.

Obamacare vs. Romneycare

An article published yesterday on the Associated Press noted that aside from constitutional issues, a major threat to Obamacare is funding.

“If the Obama plan hits all of its spending targets and realizes all of its projected revenues and savings, it would have minimal impact on the federal budget deficit through 2018. But in following years, the plan would begin running a deficit that would grow to nearly $50 billion annually, according to CBO projections revised last month. In addition, there are good reasons to believe that the Obama plan will run much larger deficits starting well before 2018.”

“The health-care plan Mitt Romney signed into law in Massachusetts is the closest parallel to the Obama plan. Since 2006, costs in Massachusetts have outpaced the original projections by more than 8%. If the Obama plan experiences similar overruns, the shortfall would be greater than $110 billion a year. Add in the deficit projected after 2018, and the Obama plan could eventually increase the annual budget deficit by as much as $150 billion in today’s dollars. Just as a benchmark, that’s about twice the amount that would be raised by ending the Bush tax cuts for people earning over $250,000 a year.

Whatever the Court’s decision, health reform will be a major issue in the Presidential race. Each side will claim the other’s plan will be too expensive and will lead to poor quality care. We are bound to see all sorts of cost projections. One good thing about our current healthcare system: it is a major engine of job growth.


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