ABC CEO Jim MacPherson

Moving Forward

In the end, it boiled down to a complex ruling on a complex law. US Supreme Court Chief Justice John Roberts stated that the insurance mandate in the Affordable Care Act was unconstitutional, but that Congress had the power to impose a tax on those who did not buy such insurance. While the Court’s liberal minority did not agree that the mandate was unconstitutional, they joined Justice Roberts because the net effect was that his view upheld the act. Ironically, as a presidential candidate, constitutional scholar Barack Obama opposed an insurance mandate because he questioned its validity. As president, however, he agreed to go along with the Congressional Democrats when they, in a failed bid to attract moderate Republican support, took the mandate idea from Mitt Romney’s Massachusetts healthcare overhaul.

While an important election looms that still could change the situation, our third branch of government has now endorsed the US joining every other developed country that views access to healthcare as an individual right of its citizens. The Supreme Court’s ruling is a very big deal, and with uncertainty removed, may make the provisions of the act more popular.

So what happens next and how will this impact the US blood community? The major provisions of the act, making insurance more available to uninsured, do not go into effect until 2014. Hospitals hope to then see more than 30 million currently uninsured patients with insurance to pay for their care.

The impact on us could be mixed, but likely more demand for blood, at least in the short-term. Patients who need blood on an emergency basis already get it. But lacking health insurance, many patients do not get transplants or other blood-intensive complex, but “elective,” care. When millions lost health insurance after the 2008 recession began, hospitals saw declines in elective surgeries up to seven percent. We saw not only the end of 2 to 4 percent annual growth in blood use, but declines overall as high as 2 to3 percent. Aging boomers will certainly use more blood in joint replacements and in heart and cancer therapies. But pressure will increase on hospitals to eliminate unnecessary care, including excessive transfusions.

More paying customers will also mean more investments and wider use of promising cell therapies, including cures for blood-intensive diseases like sickle cell anemia and hemophilia, as well as treatments to make all those joint replacements and heart surgeries unnecessary. The future just got more interesting.

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