While hardly anyone would benefit outright if reform stalls, the status quo would benefit some more than others. Here's how a few groups and industry segments would fare if Congress adjourns without passing a reform plan.
The uninsured and those in danger of losing their insurance. The uninsured stood to gain the most from reform and therefore stand to lose the most should nothing pass.
"(Healthcare) prices have moderated now, but after the healthcare debate subsides prices will skyrocket again, making insurance less and less affordable," said Ron Pollack, executive director at Families USA, a consumer group that supported the Clinton reform plan.
The Department of Veterans Affairs healthcare system. The VA has, for the last year, put off many needed changes as it waited for healthcare reform to pass Congress. The system badly needs the infusion of new, privately insured patients, not to mention the more than $3 billion in infrastructure funds that the Clinton plan would have brought.
Earlier this month, the Paralyzed Veterans of America told Congress that failure to pass any reform or a minimal incremental plan would "place the VA in its most untenable position."
Providers that rely heavily on Medicare and Medicaid. No matter what happens, Congress is likely to continue to look for spending reductions in Medicare and Medicaid to reduce the deficit. When the last budget battle was fought in Congress, providers staved off larger Medicare spending reductions by arguing that the revenues from the cuts should be saved to pay for healthcare reform. Groups such as the Bipartisan Commission on Entitlement and Tax Reform aren't likely to accept that strategy again.
"If anything, the pressure to take bigger Medicare and Medicaid cuts is only going to get worse because healthcare reform was supposed to take some of the pressure off the budget deficit," said Mike Rock, a lobbyist for the American Hospital Association.
Public hospitals. State and local governments, many of which were relying on reform to reduce their healthcare burden, are going to face increased fiscal pressure if reform is stalled. Medicare and Medicaid cuts also would hit public hospitals hard. Another area of concern is illegal aliens. Public hospitals fought to ensure that the Clinton plan included a funding stream to cover illegal aliens only to see it stripped away as cost became a concern.
"Support for vulnerable populations was unpopular in the context of (healthcare) reform, but you could get it through under the guise of universal coverage," said Christine Burch, executive director at the National Association of Public Hospitals. "Without healthcare reform, there is not much chance of funding care for these populations."
Physician specialists. The use of gatekeepers and other methods of reducing the utilization of specialists will increase in the absence of a rational system of cost containment. Specialists fear government reform, but they may soon fear managed care more.
Sole practitioners. The pressure to join managed-care groups is going to increase, as will the overhead and hassles of maintaining a practice. Reform, through some of the American Medical Association-sponsored provisions to protect a patient's choice of physician, might have helped. They also would be hit hard by any Medicare and Medicaid cuts.
Group practices. These were the darlings of private health system reform and the model for integration, and they should continue to be just that.
"Group practices are continuing to integrate, mergers are commonplace, and everybody is figuring new ways to work better with their competitors," said Brent Miller, director of government relations at the American Group Practice Association. "We would welcome any movement toward universal coverage, but we will continue to change the market without any reform."
Large employers. While the problem of cost shifting is only going to get worse, large businesses have been aggressive in controlling costs through managed care.
"Businesses are just starting to get control of costs," said Craig Sadick, senior director of government relations at the National Association of Wholesaler-Distributors. "They will continue to beat up on the market to keep costs down."
Primary-care physicians. As managed care expands, so does the demand for generalists. Also, Medicare's resource-based relative value scale, which changed the way the program paid physicians, has narrowed the reimbursement gap between generalists and specialists.
"Most of our members wouldn't fare too badly (if reform doesn't happen)," said Charles Huntington, director of the Washington office of the American Academy of Family Physicians. "Physicians coming out of school are receiving a lot of good offers, as are established practices."
Health insurers. The recent slowing of medical inflation has resulted in increased profits for health insurers, according to the Health Insurance Association of America. If insurance companies are able to continue medical redlining, there is no reason to believe they won't remain profitable.