Recently, the Supreme Court handed down its decision regarding the constitutionality of some aspects of the Affordable Care Act (ACA). Within seconds of the decision being announced, I started to receive e-mail expressing views on the decision. For reasons beyond my understanding, I receive e-mail from sources across the political spectrum; hence, the e-mails reflected the polarized tone of many debates on the legislation. The conservative leaning e-mails had a doomsday tone and lamented the loss of individual liberties and condemned the tax. The e-mails from liberal sources stressed the benefits already realized (i.e., young adults being covered on parent's insurance and elimination of preexisting conditions) and of the increased attention on health promotion for individuals and the public.
Regardless of one's political stance, the ACA implementation proceeds and proactive actors have mobilized to be ready for the next mandated elements. For example, Colorado has been busy establishing Health Insurance Exchanges (HIE; Goldman, 2012), and one study has looked at the effect of a state HIE on hospital productivity (Thompson, Huerta, & Ford, 2012). As I look at the elements to be rolled out between now and 2014, the requirements in the ACA regarding Medicaid expansion and use of the accountable care organizations stand out. These will have substantial impacts on the health care system as a whole, strategic decision making, individual health care providers, and the fiscal status of states.
From both science and practice perspectives, the implementation of these next elements of the ACA presents opportunities and challenges. Questions abound. What do we know about how providers decide to accept Medicaid clients, and what insights from that body of literature can help inform both future policymakers and current health care executives? How can health care organizations be poised to leverage increased demand for health care services that results from having insurance, at the same time that the health care workforce supply lags in capacity to meet that demand? Most of the publications on HIEs focus on the economics and insurance rate setting (e.g., Ericson & Starc, 2012). What role will health care organizations play in establishing and managing HIEs and what health information technology changes will need to be addressed? Accountable care organizations are being initiated this year by the Centers for Medicare and Medicaid. What limits will be encountered in becoming an integrated or a larger integrated health care organization, and will market forces drive strategic planning?
These questions are on the top of my mind. But there are dozens of similar questions, possibly with answers. Now is the time for the HCMR audience to step forward with innovative, yet rigorous, thinking that might be useful in the current hyperturbulent health care environment. My call to the HCMR readers and future authors is this: Let's face the challenges associated with the ACA implementation with evidence, innovation, and at least a pretense of rationality.
L. Michele Issel, PhD, RN
Editor-in-Chief
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