Around New Jersey, business reaction to the Supreme Court's decision to uphold the Affordable Care Act has been mixed, but most in the health care industry were immediately supportive of the ruling.
QualCare Inc., a Piscataway-based self-insurance firm that holds plans for more than 800,000 people in New Jersey and the surrounding area, already has been working on accountable-care organizations — groups of providers coordinating care for entire populations — as outlined in the ACA.
"From every vantage point, we see this decision as a win-win," said Annette Catino, president and CEO of QualCare. "The consumers will see a greater effort to control health care costs and keep the focus on providing the highest quality of health care. Physicians will now be rewarded for coordinating care, young adults will be able to stay on their family's health plans and small businesses should be incentivized to offer insurance to their employees."
Horizon Blue Cross Blue Shield of New Jersey's chairman and CEO, Robert A. Marino, said in a statement the decision does not change the way the state's largest insurer moves forward with so-called ACOs and other initiatives to comply with the act and provide affordable options for the state. The company has explored ACOs and other initiatives through its Horizon Healthcare Innovations spinoff.
Betsy Ryan, president and CEO of the New Jersey Hospital Association, said the measure has had its supporters and detractors, but "there's widespread agreement that our health care system is unsustainable on its current course, and changes are needed to make health care both high in quality and high in value."
"Hospitals and other health care providers have already invested greatly in efforts to improve health care quality, to make care delivery more coordinated and seamless, and to make health care services more cost-effective," she said in a statement. "The Affordable Care Act will provide the policy foundation to support those efforts moving forward."
Dr. David Shulkin, CEO of Morristown Regional Medical Center and head of several Atlantic Health accountable-care organizations, said many providers he had reached out to while building the ACOs said they were going to wait on the sidelines until court decided.
“It is clear there is no place to sit on the sideline anymore,” Shulkin said.
Shulkin said there are 1,400 physicians participating in Atlantic’s ACOs, who are responsible for the care of roughly 50,000 Medicare patients.
While helping hospitals is not the goal of the law, Shulkin said the act will increase the numbered of insured patients and market pressures to decrease cost. He said he anticipates the decrease in cost shifting between uninsured and insured patients will lower costs all around for New Jersey.
“It’s clear what our job as health care leaders is going to be over the next couple years. It’s going to be to continue to find ways to expand access that largely means finding ways to expand our primary care base and models of care that provide preventative care and access to care besides our hospital emergency rooms.”
The life sciences community also has been watching the battle over the law unfold. Debbie Hart, president of BioNJ, said she thinks much remains to be sorted out, and her association — the voice of biotech companies in the state — "will be watching it closely, and we'll be taking a lead role in educating our members on what it means for them and how they can tap into this important legislation and opportunity."
While there was a definite need for health care reform, Hart said, a piece of reform legislation as large as ACA is "always a mixed bag."
She also noted that the ACA included the Qualified Therapeutic Discovery Project Program, which handed out $1 billion in tax credits and grants to biotech firms, of which New Jersey companies got $52 million. So at least in that regard, she said, ACA is very popular with BioNJ's membership.
New Jersey's next move will be to build a state health exchange, something State Sen. Joe Vitale (D-Woodbridge) said he's eager to do.
Vitale said he was "pleasantly surprised — I'm more than that" by the ruling, and said hundreds of thousands of state residents would have health insurance as a result of the ruling.
Vitale said he would support expanding Medicaid eligibility, adding that the state would benefit from added federal subsidies under the law. Without Medicaid expansion, he said, more residents would participate in the state's health exchange.
Thomas Considine, former commissioner of New Jersey’s Department of Banking and Insurance and current chief operating officer of MagnaCare, said he expects New Jersey to move full speed ahead with establishing the insurance exchange, but what comes out of the Legislature will look nothing like the bill already passed, given Gov. Chris Christie’s veto.
Considine said MagnaCare “would have continued, and now will continue” building vertically integrated health care providers “in a way that will allow (us) to participate in shared savings.”
Contributing: Jared Kaltwasser, Andrew Kitchenman