VCU Health System CEO Offers Insight on Supreme Court’s Affordable Care Act Ruling

By Eric Peters

Sheldon Retchin, M.D., CEO of Virginia Commonwealth University Health System and vice president for health sciences at VCU, is one of the country’s most qualified hospital administrators available to address the Supreme Court's ruling on the Affordable Care Act.

The law aims to improve the current health care system by increasing access to health coverage for uninsured and underinsured Americans and introducing new protections for insured Americans.
That increased access would include coverage for nearly 32 million people. Half of that pool would gain access through an expanded Medicaid program financed for the first three years almost entirely by the federal government.

In 2007, Retchin testified before a congressional committee about proposed Medicaid regulatory changes on behalf of the Association of American Medical Colleges, AAMC. Considered a national expert in health policy and health care delivery, he has had appointments on numerous national panels related to the costs and quality of care, including being one of the original technical advisors for Medicare’s Consumer Assessment of Health Plans study.

The remaining half of the Affordable Care Act’s 32 million newly insured people “would be covered through health insurance exchanges,” Retchin explained. “This would be through a federally subsidized program that would allow individuals to seek health insurance through mostly the private sector.”

Retchin says the law’s effect on insurance rates depended upon the court’s ruling on the most contentious aspect of the law, which requires eligible uninsured people to take up insurance or pay a fine.

The majority of those people will be healthy, he said, so their inclusion in the insurance system would mitigate extra costs brought on by other components of the law and would likely not affect rates.

“If the individual mandate is overturned by the Supreme Court, however, then the rates definitely would be affected because there are some elements currently required (by the Affordable Care Act) like pre-existing conditions and covering dependents until the age of 26, those are added costs,” he explained before the ruling.

Retchin is also regarded as a national expert on the role of the safety net in health services delivery.  He was elected a 2012-2013 National Association of Public Hospitals and Health Systems (NAPH) executive committee member. NAPH is the only national organization representing the interests of safety net hospitals and health systems before Congress and the presidential administration.

A safety net hospital is one that focuses a large part of its health care on vulnerable populations that have trouble getting care due to uninsurance or underinsurance. VCU Medical Center is one of the leading safety net health care providers in the country. Roughly 45 to 48 percent of its patients are uninsured or only covered by Medicaid.

It would seem that the safety net hospitals stand to benefit from their uninsured patients becoming insured, Retchin said, but the Affordable Care Act has a plan to reduce some funding to safety net health systems.

“As those payments are cut, unless they are entirely in sync with the rise in reimbursement, the safety net systems are going to be jeopardized,” he said.
Overall, Retchin said the Affordable Care Act will likely only affect quality of care as it pertains to the uninsured and underinsured.

“Covering 32 million more Americans who currently get a lot of their care through inaccessible clinics or free clinics, but mostly end up in the emergency room - covering them is going to improve the quality of their care immeasurably,” he says. “But for individuals currently covered and for health systems that are probably not safety net and will be affected only minimally by the Affordable Care Act, their quality imperative is preceding a pace anyway because the climate for quality and the appetite for value from purchasers … is already unfolding, so everybody is chasing the quality imperative and I think that’s a good thing.”

Interviews with Dr. Retchin can be conducted by phone, in person or using the university's VideoLink ReadyCam studio. ReadyCam transmits video and audio via fiber optics through a system that is routed to your newsroom. To schedule a live or taped interview, contact the VCU Office of Communications and Public Relations, 804-828-1231.