Healthcare Reform – The Kentucky Case Study

Unintended Consequences:
Kentucky’s Experiment with Health Care Offers Lessons For Nation

Experience with health care reform in the mid-199os holds important lessons for the nation as the u.s. Supreme court prepares to rule on the constitutionality of the federal Patient Protection and Affordable Care Act.

One key issue is whether the federal government can require individuals to purchase health insurance — and whether the major reforms in the law could work as Congress intended if the Court finds that Americans do not have to obtain coverage.

The Supreme Court is considering the Obama Administration’s appeal of a ruling by the 11th U.S. Circuit Court of Appeals in Atlanta last summer finding this “individual mandate” provision to be constitutionally flawed. If the high court strips the coverage requirement but leaves the insurance market reforms intact, many experts predict that what is left of the law will not be workable.

This is because health insurance works best when costs are spread among a broader universe of people — young and old, healthy and sick. When the costs associated with the risk of becoming sick are more equally distributed, costs for everyone in that group are lower. If the high court strikes down the requirement that all Americans obtain coverage, experience shows many healthy people will opt out of health insurance and defer purchasing insurance until they are ill or injured.  Since insurers will still be required to cover anyone who applies, regardless of health status or pre-existing conditions, the risk pool will be left with an imbalance in the ratio of sick people to healthy people. Without the balance provided by a stable risk pool, costs will rise for everyone, which goes against the goals of the federal reform law. The escalating cost of premiums will lead more people to drop coverage, especially healthier individuals, causing further rate hikes for those who remain.

See how Kentucky’s experience with healthcare reform offers lessons for the entire nation.  Download the case study to read more.

This is an important conversation to have within the healthcare community in Kentucky and Southern Indiana.  While the topic has become very political, the results on the healthcare consumer and those that deliver life-saving care is significant.  If you would like to be part of the conversation, please contact the Ben Keeton, publisher of Medical News.  We will engage in a series of meetings and discussions to talk about the changes in healthcare and how it will change the way we work in the business of healthcare.