Realities drive change in health care delivery: The hospital, insurance and medical device fields are in the midst of seismic changes as they seek to transform the delivery of health care in the U.S. Regardless of whether the Patient Protection and Affordable Care Act passes Supreme Court muster, these industries are responding proactively.

• Author: Bolch, Matt
• Position: HEALTH CARE - Legislation

Two years to the month after President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA), the U.S. Supreme Court will take up the controversial issue during oral arguments in March. A decision is expected before the 2012 presidential elections, and likely during the summer.

Love it or hate it, PPACA legislation and related regulations have set the health care industry on an uncharted course of changes that, if implemented fully, will transform how health care is delivered and paid for. Whether these changes will bend the cost curve of providing care remains to be seen, but annual double-digit premium increases have led employers to limit health coverage or force workers into high-deductible health plans that make employees more financially responsible for their own health care.

According to research from the Kaiser Family Foundation, the United States spends more per capita on health care than any other country. That spending as a percentage of the gross domestic product has risen from 9 percent in 1980 to 16 percent in 2008, a figure that threatens to top the 20 percent mark in a few years if drastic changes aren't forthcoming.

Portions of the legislation have already taken effect, including raising to 26 the age limit that dependents can stay on their parents' insurance policy, removal of lifetime coverage limits and cost-sharing on preventive services. But larger issues, such as the establishment of state insurance exchanges and the individual mandate that everyone must purchase insurance or face a fine, remain in flux because of pending litigation before the high court.

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Federal appeals courts have split on the individual mandate issue and many states are waiting for the Supreme Court ruling before establishing exchanges from which individuals may purchase insurance that the law requires in 2014.

Insurers React to Mandates

Regardless of how businesses view health care reform, there is little doubt that the contentious issue will continue to dominate headlines for years to come.

"It's important people understand that the health care reform law should have addressed cost, quality and accessibility," says Joseph M. Zubretsky, senior executive vice president and chief financial officer at Aetna Inc., one of America's largest providers of health care, dental, pharmacy, group life, disability insurance and employee benefits. "But the legislation really wound up addressing accessibility by making the product more available and accessible to small groups and individuals. It did nothing to increase the quality of health care or address the cost."

Zubretsky believes the private sector was better suited to deal with rising health care costs, but proponents of reform would argue that the private sector had decades to deal with the issue and did nothing, leaving nearly 50...