The Affordable Care Act: Leadership Challenges after Affirmation

We have two areas of research and teaching: conflict resolution and negotiation in healthcare and crisis leadership. With today’s Supreme Court decision, these two come together in dramatic fashion.

One of the lessons that we teach crisis leaders is that each event is actually many events. On its face, the Supreme Court’s decision is a legal event. Lawyers argued before Justices about whether the government can require citizens to buy a product – health insurance – and other technical legal issues. In taking its action today, however, the Court also catalyzed a political event and people on the left and right will maneuver to use the decision to best advantage. Opponents of the Affordable Care Act have vowed to continue the fight. Closely tied to this is the media event that has been ramping up as the decision has come closer. Media outlets play off the decision in ways that they think will garner them the most viewers or readers.

These are the events that will get the most attention over the next few days. However the most significant impact for those of us in healthcare will extend far beyond these.

There will be a clinical event as doctors, nurses, and other professionals move to implement the provisions of the Affordable Care Act. While the Court decision is clear, how to implement the law is still being worked out. Many decisions and much negotiation lay ahead.

There will be a business model event as Accountable Care Organizations and other structures emerge in the attempt to lower costs and improve outcomes. Insurers, administrators, policy makers, and providers will have to come together and craft ways to move forward within the context of the provisions of the Act. Roles and responsibilities will shift within organizations creating the potential for collaboration or conflict. Whether stakeholders proceed as ideologues or problem solvers will determine how productive these efforts will be.

There will be a patient event as people endeavor to discern what exactly the individual mandate means for them. They will have questions for their doctors, insurance companies, and elected officials. Perhaps the most important fallout from this decision is the need to create clarity for patients: Where should they turn? What should they do? Will they be protected when they fall ill?

While there are many common stakeholders in these events, the dynamics of each are distinct. There are different interests, motivations, incentives, and reservoirs of power that will motivate action. Leaders must perceive and appreciate these as they navigate the days ahead. Each of these must be recognized – even if one finds them objectionable – if one wants to foster the confidence necessary to unearth innovative solutions to the health care challenges we face. Each party must be heard. Only then will they listen to others. Listening, in turn, is the necessary first step to cooperation and collaboration.

The crisis would have been more significant had the Act been overturned because it would have been necessary to undo the implementation that has already begun. The leadership challenges ahead, however, are significant. There will be battles, confusion, and angst. There will also be ample opportunities to come together, to create, and to heal. Our sincere hope is that both proponents and opponents of the Affordable Care Act will move beyond the legal and political events to focus on the very human events of nurturing health and providing health care.

Leonard J. Marcus, PhD, Barry C. Dorn, M.D., and Eric J. McNulty are co-authors of the second edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration (Jossey-Bass, 2011). Marcus is founding director and Dorn faculty for the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health. McNulty is Senior Associate for the program.

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