Supreme Court upholds healthcare reform law: Dermatologists react to recent ruling

Washington - Thursday’s five-to-four vote by the U.S. Supreme Court to uphold the Patient Protection and Affordable Care Act (ACA) as constitutional will result in sweeping healthcare system changes for patients and their doctors.

Justices ruled the individual mandate requiring most Americans to obtain health insurance or pay penalties starting in 2014 is constitutional, as a tax, according to news reports.

As part of the law, Medicaid will expand to including millions of low-income Americans. The opinion opens the door for Washington to offer more funding to states to expand the program, but says the federal government cannot withhold existing Medicaid funds from states for not participating.

Susan Weinkle, M.D.

These big-news items appear to be good moves for dermatologic and other patients, according to American Society for Dermatologic Surgery President Susan H. Weinkle, M.D. It’s the unknown nuances of the 2,000-page reform document that remain a concern, she says.

The good news: Dermatologists will have a greater number of people having access to lifesaving care during the current skin cancer epidemic, Dr. Weinkle says.

“However, we … the American Society for Dermatologic Surgery, are still extremely concerned about some provisions of this healthcare reform. Specifically, that Medicare’s flawed payment formula, sustainable growth rate, has not been addressed. The Medicare Independent Payment Advisory Board will have few physician representatives, and that’s a concern to us. Also, the issue of liability reform has not at all been addressed.

“So, from the ASDS perspective, see it as a mixed bag for dermatologic surgery,” Dr. Weinkle says.

Daniel Siegel, M.D.

Daniel M. Siegel, M.D., president of the American Academy of Dermatology Association, agrees:

“Throughout the health reform debate, the American Academy of Dermatology Association has supported the principles of quality care, efficiency, and a patient-centered approach to health care delivery,” Dr. Siegel said in a statement. “While, in many respects, the health system reform law does not fully align with the AADA’s health reform principles, there were some positive changes with respect to insurance reform, the expansion of health care coverage to more Americans, and strengthening of wellness efforts that were included. Unfortunately, the ACA missed an opportunity to permanently fix the flawed Medicare physician payment formula or enact meaningful liability reform, and created the Independent Payment Advisory Board (IPAB), all of which threaten to undermine access to care and destabilize health care delivery.”

Sandra Read, M.D., a Washington-based dermatologist and chairwoman of the AAD’s political action committee SkinPAC, says the ruling lays promising groundwork, but the specialty has work to do to ensure proper reimbursement from a growing patient base.

"This means that 40 million Americans will get health insurance and, therefore, access to healthcare. This is good for Americans - it will help create a healthier population,” Dr. Read says. “Our specialty needs to make sure that our patients skin health is protected, and that dermatology services are covered for our newly insured patients.”

Greater accessibility to dermatologic care may also mean catching skin issues and diseases in earlier stages, Dr. Read says.

Sandra Read, M.D.

“Because more people now have access to dermatology care, we can hopefully decrease the ravages of skin cancer and skin diseases, which impact our patients’ lives and their ability to work and live healthy lives. I am hoping that patients will come in earlier to my dermatology practice when they develop a rash, or notice a changing mole,” she says.

AMA input

In a statement the day of the ruling, the American Medical Association lauded the Supreme Court’s decision.

“This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded healthcare coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive,” The AMA wrote. “The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans.

“The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork,” the AMA continued. “It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.”

The ruling is considered a victory for the Obama Administration, and could provide a boost for President Obama’s re-election campaign. The controversy surrounding “Obamacare” continues, however. “Today's ruling underscores the urgency of repealing this harmful law in its entirety," House of Representatives Speaker John Boehner said in a statement minutes after the ruling.

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More on the Supreme Court ruling on healthcare reform

Supreme Court ruling impact: More patients, little help with costs(Medical Economics)

Health reform survives(Formulary)

ACA, including its individual mandate, upheld by Supreme Court(Drug Topics)

Affordable Care Act upheld; urologists concerned about 'key aspects' of law(Urology Times)

Court rules for ACA; traveling industry should benefit(Healthcare Traveler)

Medicaid expansion will stand with revision(Managed Healthcare Executive)