Outside the Supreme Court building last month, the crowds of people proclaiming their support or opposition to the Affordable Care Act proved that the federal health care overhaul remains a divisive and highly partisan issue.
Stakeholders on one side of the political spectrum touted the law's current and future benefits, while stakeholders on the other side called for a complete repeal of the legislation.
Despite the heated debate, there is one aspect of the health reform law that historically has bridged the partisan divide: health information technology.
Health IT in Health Care Reform
About a year before the passage of the Affordable Care Act, President Obama took one of his first steps toward reforming the U.S. health care system by signing the 2009 federal economic stimulus package. The package's HITECH Act authorized Medicaid and Medicare incentive payments for health care providers who demonstrate meaningful use of certified electronic health record systems.
When lawmakers started crafting the Affordable Care Act, the idea of leveraging IT to improve the U.S. health care system carried through. Several provisions of the legislation -- such as those related to health insurance exchanges, accountable care organizations and greater government transparency -- rely on a strong IT foundation.
State Health Insurance Exchanges
IT is a crucial component of the statewide health insurance exchanges mandated under the reform law. According to a January report from the National Conference of State Legislatures, state officials are prioritizing efforts to establish such exchanges to meet the January 2013 deadline for having some infrastructure in place. Although California is one of only 14 states to have already created an insurance exchange, it still will need to find a vendor to manage the IT framework necessary to operate the system.
Interestingly, public support for the statewide health insurance exchanges isn't quite as divided as public support for the entire health reform law. According to a January Harris Interactive/Health Day poll, nearly 60% of U.S. adults want to keep in place the reform law provision that calls for setting up online, state-based health insurance exchanges.
Accountable Care Organizations
When CMS released its final rule on Medicare accountable care organizations this fall, the agency actually removed a health IT-related provision. The final rule scraps the requirement that at least 50% of physicians participating in the ACO program achieve meaningful use of EHRs. The change came after organizations like the American College of Physicians expressed concern that many health care providers, particularly those in smaller practices, would not be able to meet the requirement.
However, the final ACO rule still includes several other provisions that involve health IT. For example, the rule:
- Retains EHR use as a quality measure;
- Allows ACO participants to use a Web-based group practice reporting option for the submission of quality measures; and
- Allows ACO participants to use survey, claims and administrative information to report quality measures instead of EHRs.
Consumer Access to Data
The U.S. government is among a number of public and private entities that has increased its focus on transparency and consumer access to data.
For example, the reform law's Physician Payment Sunshine Act requires medical industry companies to disclose all payments, consulting fees, travel reimbursements, research grants and other gifts that they give to physicians and teaching hospitals. CMS plans to post the payment information on an easily searchable public website.
In addition, a proposed rule mandated by the reform law would help certain organizations access Medicare data to compile quality and safety reports about physician practices, hospitals and other health care providers.
The overhaul also called for the creation of the HealthCare.gov website, which now offers data on health insurance rate hikes organized by state and an online tool to help small businesses compare health plans.
Without Health Care Reform, Would Health IT Keep Going?
If the Supreme Court strikes down the entire health reform law, there could be some fallout for health IT. States might cancel their IT contracts for health insurance exchanges, the federal government could scrap the ACO program and the transparency initiatives included the overhaul might grind to a halt.
But compared with other components of the reform law, health IT is likely to emerge relatively unscathed.
That's because the idea of leveraging health IT to improve the country's health care system historically has drawn support from both sides of the aisle. For example, former Senate majority leaders Bill Frist (R-Tenn.) and Tom Daschle (D-S.D.) worked together on the Bipartisan Policy Center's Task Force on Delivery System Reform and Health IT, which released a report last year about health IT progress under the stimulus package. And Daschle worked with Republican presidential candidate Newt Gingrich to co-write the forward of a 2010 book titled, "Paper Kills 2.0," which offers examples of how federal support for health IT could improve the health care system.
Carla Smith -- executive vice president of the Healthcare Information and Management Systems Society -- told California Healthline that even if the Supreme Court ruling puts the brakes on the ACO program, statewide health insurance exchanges and the reform law's transparency initiatives, health care organizations will continue to "harness the power of information technology to realize improvement in care."
Smith emphasized that the high court's ruling will not affect the meaningful use program because the 2009 HITECH Act is an entirely separate piece of legislation from the 2010 Affordable Care Act. Regardless of how the Supreme Court rules, hospitals and health care providers will continue implementing EHR systems and working to meet the requirements of the meaningful use program, she said.
However, a report released last week by the office of Sen. Sheldon Whitehouse (D-R.I.) draws a different conclusion. According to the report, the ACO program and other delivery system changes included in the reform law support the goals of the HITECH Act by emphasizing the use of technology to improve care and reduce costs. Therefore, the report contended, dismantling the reform law could remove those beams of support for the meaningful use program and slow health IT adoption.
Could Health IT Restore Bipartisanship in Health Care?
The vitriolic debate over the Affordable Care Act seems to suggest that there is no common ground on health care issues in Washington, D.C. -- not on the steps of the Supreme Court, and not in the halls of the Capitol.
Could that partisan divide spread further, and strike a wedge into the long-standing bipartisanship of health IT? Smith says she doesn't think that's likely. "The support for health IT on both sides of the aisle continues to be strong," she said, adding that such support "has been unaffected by the discussions and the debates around the health reform law."
She said, "Members of both parties get it. They absolutely understand that health care needs to be transformed in this nation. They may have very different ideas about how to achieve that transformation, but everybody agrees that the system as it currently works needs to change."
As the nation awaits the Supreme Court's decision, here's a look at other health reform news from the past week.
- Last week, President Obama emphasized his administration's record on providing women with greater access to health care services. Speaking at the White House Forum on Women and the Economy, Obama said, "Because of the [federal] health reform law we passed, women finally have more power to make their choices about their health care." In a report that was released to coincide with Obama's speech, the White House Council on Women and Girls also highlighted how women have benefitted under the health reform law (Pecquet, "Healthwatch," The Hill, 4/6).
HHS has announced the 10 states that will receive grants totaling $72 million to set up or expand home visitation programs for pregnant women, parents, caregivers and children. The grants are part of the Maternal, Infant and Early Childhood Home Visiting Program, which was established under the federal health reform law. HHS Secretary Kathleen Sebelius said the visitation programs can "help provide skills and links to important services and early childhood education" (Pecquet, "Healthwatch," The Hill, 4/3).
Eye on the Courts
- Last week, U.S. Supreme Court Justice Antonin Scalia declined to comment on President Obama's assertion that striking down the federal health reform law would be an example of judicial activism, according to Rep. Peter King (R-N.Y.). When asked during a Federalist Society breakfast in New York whether he wished to comment on Obama's claim, Scalia replied, "Nope," and he "just sort of smiled when I said it," King said (Kasperowicz, "Floor Action Blog," The Hill, 4/4).
On the Hill
- Last week, House Minority Leader Nancy Pelosi (D-Calif.) said she expects the U.S. Supreme Court to uphold the federal health reform law in a 6-3 vote, but said "you never know what the court will do." Pelosi -- during a luncheon at the Paley Center for Media in New York -- said she is confident that the bill will stand because "we wrote the bill in an iron clad way." Pelosi also criticized Republicans for asking the high court to overturn the law. "They were not big fans of the courts ... until now," she said, adding, "Now they support judicial review" (Geiger, Los Angeles Times, 4/4).
- Republicans are developing alternatives to the federal health reform law in the event that the U.S. Supreme Court overturns the entire law or some of its key provisions, such as the individual mandate. GOP lawmakers say they are committed to fulfilling their promise to replace the overhaul should the court strike down the entire law, but they acknowledge that they have much work to do to develop a comprehensive plan (Pear/Weisman, New York Times, 4/3).
Rolling Out Reform
- Over the past two years, the Obama administration has "quietly" provided the Internal Revenue Service with about $200 million and it plans to provide more than $300 million this year for the implementation of the federal health reform law, according to data provided by a congressional aide. The money is part of a $1 billion implementation fund created under the overhaul. Although the funds are being provided outside the regular appropriations process, the Government Accountability Office has said the transfer is legal and consistent with previous transfers of general implementation funds (Baker, "Healthwatch," The Hill, 4/9).