Supreme Court 'Obamacare' Decision Will Speed Health Insurance Exchange Growth

With the Supreme Court upholding the Affordable Care Act's requirement that citizens must purchase health insurance, experts say tech vendors will abandon their waiting period and proceed with health insurance exchange development.

The U.S. Supreme Court€™s 5-4 decision on June 28 that upheld the primary provision of the Patient Protection and Affordable Care Act requiring citizens to purchase health insurance will quicken the development of Web-based health insurance exchanges, according to health care industry experts.

The development of these exchanges was in a bit of a wait-and-see phase until the Supreme Court ruled, and now development will pick up, according to Jordan Battani, managing director of the CSC Global Institute for Emerging Healthcare Practices.

"These challenges and court cases have caused everyone to go slow," Battani told eWEEK. "Health plans have a lot of work to do to interact with those exchanges enabling back-end transactions."

In addition to implementing the exchanges themselves, health insurers must integrate their back-end electronic enrollment, fufillment, billing and reconciliation systems with the health insurance exchanges, said Battani.

Open enrollments for health insurance exchanges (HIXes) must begin in late 2013, Battani noted.

Voting in favor of the Affordable Care Act were Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor. Chief Justice John Roberts, who was appointed by President George W. Bush, cast the deciding vote in favor of the health care legislation championed by President Barack Obama€™s administration and adopted by Congress in early 2010.

Dissenting were Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas.

The court's reasoning was that the government maintains the power to tax, and to penalize citizens for not purchasing insurance is a form of taxation.

Even if the Affordable Care Act is ultimately repealed by Congress, work in developing HIXes will not go to waste, said Battani.

"Comparison shopping for coverage is a very compelling model for creating a sales channel for individual and group coverage," said Battani. HIXes will resemble travel-shopping sites like Travelocity and Expedia, she said.

The incentive program for meaningful use of electronic health records (EHRs) falls under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and was unaffected by the Supreme Court's decision on ACA.

However, the ACA plan does include a Medicare Shared Savings Program (MSSP), which was also upheld. MSSP provides incentives for doctors to create accountable care organizations (ACO) if doctors collaborate over the life of a patient.

EHRs and health information exchanges (HIEs) make this collaboration possible, Battani noted.

Still, health care providers were likely to continue forming ACOs even if the Supreme Court had struck down the ACA.

One vendor, Castlight, offers a mobile tool that allows consumers to shop for health care plans on Apple iOS and Google Android devices.

"With 20 million to 30 million individuals adding health insurance, there is an even larger pool of people needing tools to help them navigate health care and find ways to save money and improve care," Castlight's CEO and co-founder, Giovanni Colella, told eWEEK in an email. "Additionally, the exchanges will add increased competition and transparency into the system, which will benefit all companies delivering meaningful innovation to the market."

On June 26, Xerox announced it will work with Florida Health Choices, an organization that the state designated to improve access to health care, to provide a cloud-based Web portal and online plan selection tool for an HIX in Florida.

"There is going to be a wave of states selecting vendors to become compliant with health reform," Will Saunders, group president for government health care solutions at Xerox, told eWEEK. "There's going to be a mad scramble for states to be compliant."

"My sense is the IT community will continue forward with solutions that support all the aspects of the ACA, including the health insurance exchanges," said Tom Leary, senior director of federal affairs for the Healthcare Information and Management Systems Society (HIMSS). "Over the past two years, facilities and industry have been developing technical, administrative and policy solutions that meet the many goals and requirements in ACA. Today's Supreme Court decision will lower one of the policy hurdles to meeting the law's requirements and allow these initiatives to move forward."

In a press call with reporters, Dave Roberts, vice president of government relations for HIMSS, called the court's decision the most significant ruling since 2000's Bush vs. Gore.

"[The ruling] now means that everyone will have insurance," said Roberts.
"The individual mandate is a way to ensure that the system is fairly funded," he said. "This level of funding will allow facilities to expand beyond the incentive program to make sure they have the technology to improve quality of care."

The Supreme Court decision upholding most of the ACA will lead to innovation in health IT, such as building a system to correctly identify patients, said HIMSS' Roberts.

"Consumers are going to be demanding ways to access information through their health systems and health plans," said Roberts. "This is just the beginning, the tip of the iceberg of innovations that we're going to see in health care."