Inmar Inc. | August 3, 2012

The June 2012 Supreme Court decision on the Affordable Care Act (ACA) was a much divided 5-4 ruling finding the ACA to be constitutional. This will be critical for all players in the healthcare industry to follow closely.

The law is intended to increase insurance coverage and make the health care system more accessible to more citizens. However, it leaves the majority of private health care in the hands of the medical insurance industry which is a behemoth of red tape and copious amounts of paperwork that is required of pharmacies, physicians and hospitals alike.

Part of the ACA is the establishment of a committee to propose cost-saving legislation to Congress and to create new payment systems that are expected to control costs. However, the legislation will take years to enact, and these simplifications of the complex healthcare system are not guaranteed. Any newly created regulations will be expensive to enforce and maintain and could possibly offset any lower costs that would be passed on to consumers.

With ACA, healthcare companies will see more individuals covered by healthcare insurance and will lead to more transactions as more citizens are accessing medical care and buying needed prescriptions. Insurance companies and retailers will have larger databases of clients to be reconciled.

Many opponents of ACA see the country moving to a single payer system as being a potential downside of the legislation. While this would theoretically simplify reimbursement, the complexity of healthcare will require many transactional services as this system can never be made simple.

Another part of ACA is the move to pay-for-performance as opposed to the traditional fee-for-service healthcare. Healthcare providers that can document the best patient outcomes and overall net reduction in healthcare costs will be reimbursed at the highest and best rates. This is an opportunity for healthcare providers to find savings and use reconciliation services to ensure they are receiving full credit for their service.

The ACA will continue to change the landscape of the healthcare industry just as it has changed the political landscape. With the legislation being implemented over several years, the impact on all of the players in this field will be felt for years to come.


  • Health Care