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What will the big stories be for the Affordable Care Act (ACA) in 2012? Access, affordability and quality win the day.  The ACA year opens with a scintillating GOP primary and election year intrigue; and the Supreme Court hears arguments on the “individual responsibility” requirement and the constitutionality of the Act.

Don't forget what the Affordable Care Act means for women:

* Free preventative screenings like mammograms

* Your children cannot be denied for a pre-existing medical condition - a new benefit already in place right now

* The end of higher medical insurance costs just because you are a woman

* No co-pay on birth control

* Your parents will benefit from stronger Medicare protections

Here’s a look at the top stories:

1)    The Supreme Court ruling: More than 100 law professors, 35 economists, and three Nobel Prize winners say there’s no doubt the new health law is constitutional.  A majority of bipartisan circuit court judges have ruled in favor of the law’s “individual responsibility” requirement where everyone must have health insurance.  This is an essential element of the Act, without which its goals to improve access, affordability and quality, could not endure.

2)    The battle for the White House: The GOP candidates want to eviscerate the Act, but even if one of them were to prevail in the general election,  it would take overwhelming agreement with a majority House Vote, White House support and 67 votes in the Senate, to abolish a law already on the books.  Don’t expect the 2012 election to be an upset for the Affordable Care Act.  The likely GOP nominee, Mitt Romney, also advocated for an individual responsibility requirement previously and passed similar health care legislation in Massachusetts. Reversing bans on lifetime limits, discrimination against those with preexisting conditions, reduced medication costs, free preventative care, and better quality, already in effect for millions of Americans will not be popular, or easy.  Americans know that the quality of their lives depends on the quality of their health.

3) Oh, Florida! Not much good news from the nation’s most unpopular governor, Rick Scott.  Scott’s extreme response in Florida to block the reforms and the federal money provided for health care access are a big political risk. Florida isn’t accepting federal monies to ready itself for the exchanges, isn’t working on accountable care projects, isn’t working to expand benefits through Medicaid, and is spending its resources in delay and legal actions against the government in order to preserve industry profit at citizen expense.  The consequence: Florida isn’t ready; its citizens aren’t covered; its healthcare future is in limbo. The federal government is poised to step in to set up the insurance exchange for its residents and has refused its request to allow Medicaid vendors to spend less money on health care.  What other assaults will the governor cook up this year? Stay tuned.

4) Expanded access to health care coverage:  Watch for those hard numbers tracking the increases in people covered under the ACA, increased protections for those covered, and increased use of services.  No more lifetime limits; more prevention, more people covered in the high risk pool, and more jobs created to fuel an effective and expanded private sector health care engine.

5)  Increased affordability of health care: Follow the money!  We’ll see more savings through better quality and less tolerance for abusive, wasteful and frankly fraudulent services.  Seniors receiving rebates as the pharmacy cost (donut hole) is reduced.  Industry will foot some of the bill for research, and caps on profit at the expense of quality.    Expect reports on the cost of premiums for states, employers, and individuals as the Health Care Exchanges rev up.  And expect stories on what its like for people who need and use care, health care professionals who provide care, and hospitals and systems that support care as our health care delivery system adjusts to a new and effective system focused on patient oriented outcomes that matter, rather than on transactions and money.

6)  Better quality of care. This year is about quality. Thirty-two health provider organizations will roll out innovative care delivery programs, called accountable care organizations, for Medicare enrollees with payment based on quality of care outcomes, rather than procedures and number of visits.   Look for stories about getting ready for evidence-based medicine approach to treatment.  The insurance industry will be contributing to the funding for the governments comparative effectiveness research initiative. The goal of this project is to make sure patients receive care that is effective.

Rome wasn’t built in a day, and neither will be the ACA. This is a big law with a big agenda for a great nation.  Already,  it is improving access.  More people are protected, covered and getting care.   Now, we are moving on to the issues of affordability and quality, initiatives that will continue to return benefits for years to come.  The individual responsibility requirement, up for a challenge in the Supreme Court this year, and health exchanges are critical to solving the affordability puzzle.

Equally important to affordability are the provisions to reduce waste, fraud and abuse, reduce payment to hospitals for avoidable readmissions, and oversight to ensure that the insurance and pharmaceutical industries contribute to fund quality initiatives and the acquire medications at competitive prices.

And for quality, this year is huge! This year, the nation’s health care entrepreneurs and providers begin the hard work to find programs that are based on innovative care models, improving quality, proving home-based care for seniors, and receiving payment based on the quality of the patient oriented outcomes that matter to people, rather than the number of procedures or visits that someone gets. This means better care, better outcomes for people, and more jobs.

The ACA solves big problems with innovative and entrepreneurial solutions.  There’s nothing more American than rolling up our sleeves and using our ingenuity to meet the important challenge of fixing our health care system.





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