[2012][Nature]Health law worries hospitals.doc
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[2012][Nature]Health law worries hospitals.doc

[2012][Nature]Healthlawworrieshospitals.doc

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MIDCONDUCTAdatadetectiveexplainshowhecrackedhiscasep.18AFRICADisputeatflagshipinstituteraisesghostsofcolonialerap.17NUCLEARENERGYProliferationfearsgreetprojectforcheapuraniumenrichmentp.16TECHNOLOGY3Dprintersgivescientistsagriponresearchp.22BYMEREDITHWADMANAhistorichealth-caredecisionbytheUSSupremeCourtholdsmixedblessingsforresearch-intensiveteachinghospi-tals.On28?June,thecourtupheldmostofthePatientProtectionandAffordableCareAct,PresidentBarackObama’ssignaturelegislativeaccomplishment.Byenablingtensofmillionsofcurrentlyuninsuredpeopletoobtainhealth-carecoverage,thelawshouldsignificantlylightenoneofthehospitals’burdens:charitycare.In2010,275ofthecountry’smajorteach-inghospitals,whichmakeuponly6%ofallhospitals,conductednearly40%ofthecoun-try’sfreecareforuninsuredpatients,worthUS$8.4billion,accordingtotheAssociationofAmericanMedicalColleges(AAMC)inWashingtonDC.Yetasbroaderinsurancecoveragereducesthosecosts,anotherofthelaw’sprovisionsisensuringthatteachinghospitalsdonotreceiveawindfall.Itcutsgovernmenthealth-carepay-mentstohospitalsby$155billionbetween2010and2019—reductionsthatteachinghospitalssaymayamounttoanetloss,hurtingtheirresearchmission.Andalthoughthecutshavealreadybeguntotakeeffect,thefinancialboostfromanincreasinglyinsuredpopula-tionwon’tbeginuntil2014,whenpeoplewillberequiredtopurchasehealthinsuranceorpayataxpenalty.“Thereisnoquestionthatthesecutsputtheabilityofinstitutionstocontinuetoinvestinmedicalresearchatrisk,”saysAnnBonham,chiefscientificofficeroftheAAMC.Somehealtheconomistsarescepticalofsuchclaims.“Alltheyaresayingis:‘Wewantmore,andwewantotherpeopletopayforit’,”saysMichaelCannon,directorofhealth-policystudiesattheCatoInstitute,alibertarianthinktankinWashingtonDC.Hebelievesthatresearchshouldnotbefundedfromthepublicpurse.ButScottGottlieb,apracticingphysi-cianandfellowattheconservativeAmericanEnterpriseInstitute,alsoinWashingtonDC,saysthatme