An Audible Whoosh

Posted in: Club Newsletter, Featured, Reflections Articles

– Stanley F. Hupfeld, FACHE, Senior Consultant, INTEGRIS Health

9-1_Reflections-HupfeldOn June 25, 2015 there was a noticeable whoosh coming from the 16 Republican candidates for president. The sound was an audible expression of relief over how to handle their individual and collective positions on the Affordable Care Act. On that day the Supreme Court decided to uphold the IRS’s interpretation that subsidies could be granted to low income Americans for the purchase of health insurance, whether that insurance was purchased through a state or a federal exchange.


Sixteen Republican attorneys general had sued the government declaring that language in the bill clearly allowed subsidies only in states with their own exchanges. If the plaintiffs had prevailed then subsidies granted in 34 states with federal exchanges would have been disallowed and six to nine million Americans would have suddenly found themselves without health insurance.


Although every Republican presidential candidate has espoused repealing and replacing the Act, none of them has proposed a substantial alternative beyond vague allusions to a market-driven solution determined by doctors and patients. It is far easier to use ACA as a whipping boy with which to score rhetorical points as opposed to having to propose a substantial alternative. The candidates can now comfortably condemn the Act without having to answer the question, “What would you do?” The Act clearly was poorly written and far too complicated, and probably too ambitious, but it does have at its core a fundamental principle – that all Americans should have health coverage.


Indeed, if, and, or when there emerges a true conservative alternative it must answer a fundamental question and that is, “Do you believe all Americans should have health insurance?” If the answer is yes, then you must articulate how you would go about fulfilling that obligation consistent with conservative principles of a competitive market devoid of additional insurance regulation and exacerbating our national debt. Providing care to millions of poor Americans based primarily on market economics would be a challenging intellectual exercise.


If your answer is no, we have no obligation as a nation to see that all Americans have access to health insurance. Then one is condemned to endorsing the status quo before the Affordable Care Act and running the risk of alienating those millions currently insured for the first time.



Stanley F. Hupfeld is senior consultant to INTEGRIS Health. He is a fellow of the American College of Healthcare Executives. He can be contacted at

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