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Sorting It Out Won’t Be Easy, Now That the Deed Is Done

MANAGED CARE April 2010. © MediMedia USA
Editor's Memo

Sorting It Out Won’t Be Easy, Now That the Deed Is Done

John Marcille
MANAGED CARE April 2010. ©MediMedia USA

John Marcille

As with all major social legislation, it will take years for the significance — and the inevitable unintended consequences — of the Patient Protection and Affordable Care Act (PPAC) to become clear.

But first, an anecdote. We now have this individual mandate. Five years ago, contributing editor Martin Sipkoff and I did a long interview with Newt Gingrich that became part of a cover story on his interesting ideas about health care reform. Many whom I know to be politically conservative applauded the article. Yet here’s the thing: If there was one message that stood out for me, it was Gingrich’s insistence that we need the individual mandate. Now, guess what political group is aiming at the mandate as a way to bring down the reform law? It doesn’t take much to amuse me.

Millions of new enrollees? What a windfall for insurers. But for the managed care industry — and this was to be expected — there’s also stuff not to like in the law. America’s Health Insurance Plans is not alone in observing that PPAC (let’s see if this is the abbreviation that catches on) doesn’t do much to hold down utilization and provider fees. At least, that is how I interpret AHIP’s brief statement that “ultimately, the success of health care reform will depend on whether or not soaring costs are brought under control and coverage becomes more affordable for working families and small businesses.”

We will be covering many of these provisions in individual articles over the next few months, or as long as it takes. This month, it’s the attack on Medicare Advantage. By rights, MA should be a growth area because these plans offer a lot of extras to beneficiaries. But on the other hand, they do cost Medicare around 13 percent more per capita, compared with traditional Medicare, so it was a tempting target. Contributing editor John Carroll tells us in the article that starts on page 14 that some MA plans will do just fine.