JACR: Much at stake in 2012 election

The results of the 2012 federal election will likely have a large impact on the future practice of radiology, and radiologists should prepare for the various outcomes in their strategic planning, according to an article published in the October issue of the Journal of the American College of Radiology.

Frank J. Lexa, MD, of the Wharton School at the University of Pennsylvania, Wynnewood, argued that the election likely will affect how much radiologists will be paid, the level of physician autonomy within their practices and the structure of power between hospitals, corporations, physicians and others.

One of the starkest contrasts between President Barack Obama and former Massachusetts Governor Mitt Romney—and the Democratic and Republican parties in general—is their stances on the Patient Protection and Affordable Care Act (PPACA). After surviving the high-profile Supreme Court decision earlier this year, Lexa painted November 6 as the next big hurdle for the healthcare reform law. Should Obama win reelection and the Democrats maintain a significant presence in Congress, they will seek to continue implementation of the law. However, should Romney and the Republicans take power, based on their public statements they would likely propose a repeal of PPACA, and pursue alternative reforms that emphasize state autonomy, health savings accounts and tort reform, according to Lexa.

“By choosing [Paul] Ryan as a running mate, Romney has made Medicare a central campaign issue,” wrote Lexa. “Radiologists should pay very close attention to the debates this fall, as the details unfold from both sides.”

Lexa outlined three broad scenarios following election day that radiologists should prepare for within strategic planning at their practices:

 - A repeat of 2008, featuring an Obama victory and strong Democratic support in Congress, which would allow PPACA to be implemented as currently scheduled. Lexa speculated that if it follows the path of state-level reforms in Massachusetts, on which PPACA was modeled, radiologists should expect healthcare costs to continue to rise, prompting a push for increased revenues and alternative models of reimbursement not based on fee-for-service.

 - A muddled political environment in which either Obama or Romney win the presidency, but must work with a Congress controlled by the opposition party. Lexa wrote that this could lead to continued political gridlock, partisan warfare, budget brinksmanship and other dysfunctional behavior witnessed in recent years, though there is the possibility that crisis could push the parties toward a grand compromise. “To a first approximation, a president would likely have a freer hand with a friendly Congress, and gridlock is more likely with an opposition party in Congress, but reality is sometimes more nuanced. There can be very poor legislative results when there is a ‘monoparty’ government, and occasionally, great legislation can emerge paradoxically from historic compromises that occur when the government is split.

 - Republicans run the table, which would likely see PPACA replaced with a plan featuring the ideas of Republican vice presidential candidate Ryan that include healthcare vouchers for individuals and block grants for states, according to Lexa.

“Under any plan, Democratic or Republican, it is hard to envision how full medical coverage for an additional 30 million people would be achievable without higher taxes in one form or another,” wrote Lexa.