Whatever Court Rules, Major Changes in Health Care Likely to Last
By REED ABELSON, GARDINER HARRIS and ROBERT PEAR
Published: November 14, 2011
This article is by Reed Abelson, Gardiner Harris and Robert Pear.
Daniel Acker/Bloomberg
The 2,409 pages of the Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010.
No matter what the Supreme Court decides about the constitutionality of the federal law adopted last year, health care in America has changed in ways that will not be easily undone. Provisions already put in place, like tougher oversight of health insurers, the expansion of coverage to one million young adults and more protections for workers with pre-existing conditions are already well cemented and popular.
And a combination of the law and economic pressures has forced major institutions to wrestle with the relentless rise in health care costs.
From Colorado to Maryland, hospitals are scrambling to buy hospitals. Doctors are leaving small private practices. Large insurance companies are becoming more dominant as smaller ones disappear because they cannot stay competitive. States are simplifying decades of Medicaid rules and planning new ways for poor and rich alike to buy policies more easily.
But how to pay for these changes, and what will happen to the 30 million uninsured Americans the law intends to cover, will be up in the air if the mandate at the heart of the law — the requirement that individuals buy health insurance or face a penalty — is struck down.
The election results of 2010 and stiff state opposition to the mandate also complicate the picture. Hospital administrators, insurers and doctors are counting on federal subsidies and coverage expansion that would result in a surge of patients with insurance to offset cuts in government programs that many fear could soon become draconian. Large health systems could then use their newfound clout to demand higher prices from private insurers even as federal and state governments pay less.

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