After King v. Burwell arguments, failing to plan is planning to fail
Healthcare, at its essence, is a waiting game.
We wait for the doctor to see us. We wait for test results. We wait for the bill. We wait to find out if insurance covered it. We wait for a reimbursement check, more test results or another bill. We wait for our next appointment.
Now we wait for a King v. Burwell verdict. Just as we do when we wait for test results, or a bill, we try not to panic. We hope for the best but prepare for the worst.
[Special Report: King v. Burwell Supreme Court case: What you need to know.]
If there's a silver lining--and it takes a cynic to find one--it's that, like Noah's pairs of animals, we're all in the same boat.
- Payers ponder how dramatically a King v. Burwell verdict will affect 2016 rates. Premiums could go up as much as 47 percent--or not much at all.
- Hospitals wonder if they will see soaring "untreated illness and overwhelming debt"--or, if the subsidies remain in place, soaring stock prices.
- States consider whether to build an insurance exchange so that residents will still be able to receive subsidized health insurance, all the while casting a wanting eye at Capitol Hill for a sign, any sign, of what the Supreme Court or Congress plans to do. State governments may have to do everything--or nothing.
- Millions of low-income Americans face the harsh reality that the health insurance they so recently acquired may no longer be affordable.
Earlier this year, FierceHealthPayer reported that King v. Burwell will be the defining moment for healthcare politics in 2015. At that time, I considered such a statement hyperbolic. If anything, it was an under-exaggeration. The case may very well define healthcare politics for a generation. Just not for another three-plus months.
Yes, Tom Petty is right: The waiting is the hardest part. But it's also a chance to reflect. A few weeks ago, I said healthcare innovation won't come to those who wait. A responsible response to King v. Burwell, no matter the verdict, won't come to those who wait, either.
Prudent payers, providers and political leaders must plan for the worst while hoping for the best. (In other words, don't follow the lead of the Department of Health and Human Services, which says it has no backup plan.)
There's nothing wrong with pressuring Congress to offer relief to insurers that must set rates, hospitals that must pay bills from the newly uninsured, states that must build insurance exchanges quickly and, above all, the millions of Americans who must pay much more for insurance in the event that subsidies must go.
However, that can't be the only thing the industry does. Organizations need a Plan B, a Plan C, a Plan D and possibly a Plan E. Like Noah, they need to figure out how to keep the lions from eating the gazelles, the mice from crawling up the elephants' trunks and the gerbils from giving everyone the plague. (Yes, gerbils. Rats, we apologize.) The task is neither easy nor enjoyable, but it's necessary if we want healthcare as we know it to survive the proverbial flood.
For as dire as things will seem if the Supreme Court does side with the King v. Burwell plaintiffs, the sun will eventually rise. Hospital doors will open, care will be delivered, payers will receive claims for that care and patients will eventually receive bills for that care.
Tom Petty also tells us, "It's time to move on. It's time to get going. What lies ahead I have no way of knowing." It's a tumultuous and uncertain time for the healthcare industry, but it's by no means a time to stand pat.
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