Michael Zaroukian, MD, Vice President and Chief Medical Information Officer, Sparrow Health System, Lansing, Mich.
On the impact of the decision on Sparrow Health's priorities: I'm not sure it changes our priorities much. We saw the HITECH Act as giving a pretty clear roadmap for us to follow in the health IT world. I think the biggest issue is knowing that there will be more patients in the system, and an even greater reason to have health information exchanges, since those patients will receive care in various settings, and basically in some ways just some excitement about the ability to make sure more patients get the care they need and don't have to make the difficult decision about waiting to get care until their care needs are more extreme than they would otherwise be.
On the ruling that states could opt out of Medicaid without a penalty: I'm empathic with the judgment that says on the one hand it's expected that states will indeed participate in one form or another of this. It is an underserved population. I think the court's view of it being a bit too aggressive or assertive to say that if you fail to fully participate in this, then you lose all of your funding, I actually resonate with that. I think many of us would. I think it's a little bit hard to say exactly what does it take for a state Medicaid program to feel whole in this process. So I think it probably is the better approach to say, given the alternative of either saying you have a choice or you lose all of your funding, it's better to allow states to have the choice. I think most states want to do the right thing with regard to covering their patients, and that they'll find their way to that process a little bit better if they aren't held against sort of an all-or-nothing participation approach.
On the possibility that the public may opt to pay extra taxes rather than purchase healthcare: I think it's a little hard to predict indeed early on, because some people will make their early decisions philosophically, but since none of this really takes place until 2014 in that regard, I think most people will make decisions based on common sense, their economic interests, their perspective with regard to the likelihood that they'll need care, and with some experience that we accumulate in the time between now and then that shows indeed what are the likelihoods. I think most people want to have the safety net that insurance provides. I think when they consider the cost of a penalty, if you will, for not doing so, versus the cost of it, they'll make the decision most of us end up making. In Michigan, there's a requirement to have auto insurance. So it's not that foreign from that perspective. That of course is a state as opposed to a federal type of mandate, but I think in the end most people will make an economic decision and talk about it within their families and decide how best to spend their money.