2012 was a watershed year for American health care.
Obamacare, formally known as the Affordable Care Act, was cemented in place legally and politically, and it entered the home stretch to full implementation. And President Obama publicly embraced the term Obamacare as a positive description of his signature legislative accomplishment.
But that was just the start. Developments throughout the health care system solidified several major transformations that were already underway.
Top ten lists are always subjective, but here, in reverse order of significance, is my take on the most important health policy developments of the year.
10. Tougher fraud and abuse enforcement
Fraud and abuse cost the Medicare and Medicaid programs an estimated $98 billion in 2011. Obamacare gave government enforcers new tools and funding to go after it, which led to a major ramp-up of prosecutions in 2012. Going forward, providers will face an environment with much greater scrutiny of their finances.
9. The Patient-Centered Outcomes Research Institute (PCORI)
This new independent board, created by the Affordable Care Act, began operation in 2012 to support objective research on the value of complex medical treatments. Opponents warned of sinister motives behind it, like attempts to start death panels and health care rationing. But the truth is just the opposite. Unbiased research will enable patients and their physicians to decide which new treatments are best for them.
8. Accountable Care Organizations
These new collaborative ventures, also created by Obamacare, combine hospitals and physicians to seek ways to make care more efficient. Their ultimate value is yet to be tested, but they have the potential to revolutionize health care delivery. More than 150 were launched in 2012 affecting care for over 25 million patients to begin the grand experiment.
7. Health care shopping websites
With greater numbers of Americans covered by high-deductible health plans, the cost of services has increasingly hit home. Internet entrepreneurs have moved to fill the need for comparative price information. In 2012, several websites were launched to guide health care consumers in what could be the start of a significant trend. Among them are Clear Health Costs and Healthcare Blue Book.
6. Electronic health records (EHRs)
There is nothing new about EHRs, but most American physicians still don't use them. A law enacted in 2009, the HITECH Act, allocates substantial funding to encourage their uptake. To get the maximum benefit, physicians were required to begin participating in 2012. EHR use could ultimately transform the provision of care.
5. Massachusetts cost control legislation
Everyone agrees that health care cost inflation is unsustainable, but the government still struggles to find ways to tame it. Massachusetts, the state that implemented the precursor to Obamacare, took the first tentative steps in 2012. Its program is limited, but it marks the first time the government at any level has acted to address the problem in a comprehensive way.
4. "Fiscal cliff" negotiations
We don't yet know where these will lead, but there is a good chance they will launch a significant discussion of ways to rein in Medicare and Medicaid spending. A long-term solution may be more than we can hope for at this point, but an exchange of serious proposals would be a solid start.
3. Gene patent litigation
Scientists first described the structure of DNA almost 60 years ago, and genomics is finally on the verge of transforming medical care. But the transformation cannot proceed until a host of thorny legal, ethical and social issues have been resolved. The Supreme Court took a first step toward resolving one of them – the right to patent individual genes – when it agreed to decide the issue this term. The outcome will do much to set the future course of medical innovation.
2. President Obama's re-election
Whether you supported him or not, it is undeniable that November's presidential election was pivotal in determining the fate of health reform, and the overall direction of American health policy. The President now has a green line to bring his signature policy initiative to full fruition.
1. Supreme Court's Obamacare ruling
The Court's ruling last June to uphold the law was a landmark in several ways. It let Obamacare proceed but also placed new limits on Congressional power. The mandate to obtain insurance was upheld narrowly under Congress' power to impose taxes, not as a permissible regulation of interstate commerce. And Congress was not allowed to compel states to expand their Medicaid programs – only to give them the option. These holdings could set important limits on the shape of new health care initiatives going forward.
With those developments behind us, hold onto your seat for 2013. That is when the nuts and bolts of Obamacare will be put in place. We could be in store for another watershed year. -Robert I. Field