"It depends how it all plays out. It could either be good or bad. We had that potential before reform, we have that potential after reform. Is it a perfect solution? It's not. Was the existing status-quo perfect? No. I think much of it is yet to be determined because many of the regulations have not been written. We don't' have an exchange in North Carolina for insurance. So is it going to help, is it going to hurt? It doesn't exist," he said.
Speaking to members of the press from his office, Paulus maintained that there will be no immediate change to the way care is provided at Mission Health. The independent, not-for-profit hospital will continue to provide care for patients — insured or not. "We are here to serve the community of Western North Carolina, period," he stated.
However, he acknowledged that the number of people insured under Medicaid has the potential to expand greatly by 2014. But, this all depends on the state. Under the Affordable Care Act, states are not required to participate in the expansion of the Medicaid program — an expansion that North Carolina's Division of Medical Assistance estimates will allow 1.1 million North Carolinians to gain insurance.
As stated in text of the Supreme Court's decision, "The ACA does not legally compel the States to participate in the expanded Medicaid program, but the Act authorizes a sever sanction for any State that refuses to go along: termination of all the State's Medicaid funding…A State forced out of the program would not only lose this huge sum but would almost certainly find it necessary to increase its own health-care expenditures substantially, requiring either a drastic reduction in funding for other programs or a large increase in state taxes. And these new taxes would come on top of the federal taxes already paid by the State’s citizens to fund the Medicaid program in other States."
Paulus, who spoke recently at a June 3 public forum about Medicaid with former state Medicaid Director Craigan Gray, said it's anyone's guess about what North Carolina will decide to do. "It's a balancing act for states, and there's a lot of fiscal pressures," he said.
For now, Paulus said the biggest pressure he must face is one that Mission Health system has been dealing with for years: provide high-quality health care at low cost to patients. He particularly emphasized a need to shift the health system from volume-based care to outcome-based care. "We still have too many incentives that reward the concept of 'more, more, more' and not what's best," he' said.
Until then, he maintained, the impact of health care reform remains more of a question than an answer, saying, "This is the beginning of a story, not the end."
Ron Paulus released an official statement about the Supreme Court's ruling on the Affordable Care Act. It is listed below in full. It can also be found online at Mission Health's homepage:
ASHEVILLE, N.C. (June 28, 2012) - Mission Health President and CEO Ronald A. Paulus, MD, made the following statement regarding the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act (PPACA) today:
Today's ruling from the Supreme Court to uphold the law now gives us direction in moving forward with healthcare reform. We are pleased that there is now clarity on the constitutionality of the law. That said, it's important to note that with or without reform, the overarching issues are the same:
•Care quality is not where we need it to be nationally, and it must be improved;
•Healthcare costs are high and growing too rapidly, and we must become more efficient;
•Even with the current law, far too many individuals are and will remain uninsured or underinsured, and as a result, they frequently don't receive the care that they need to prevent and manage illness in an optimal manner;
•Inappropriate incentives hard-wired into our system reward "more" rather than best outcomes.
Mission is committed to working with our community to address these problems in a collaborative, effective and transparent manner. Even while ranked by Thomson Reuters as one of the Top 15 Health Systems nationally, our work has only just begun. Of course, we will work with our staff, community leaders, legislators and others to comply with the law and achieve the necessary changes described in the ruling.
The full text of the Supreme Court ruling can be found at the New York Times here.
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