05/03/2012 02:57 pm ET Updated Jul 03, 2012


A week ago I had the chance to attend a breakfast seminar at the Denver Tech Center Marriott with a few hundred administrators and executives from Colorado's hospital corporations, medical insurance companies and assorted health care providers. This was a well-dressed, confident and comfortable bunch. The subject du jour was ObamaCare and the "Implications of the Supreme Court Decision on States." I arrived anticipating some degree of organizational anxiety; yet, during introductions, I witnessed a sequence of chest-thumping announcements regarding a new hospital, patient treatment and specialty care facilities planned or under construction. Then, I picked up my Sunday Denver Post to read about the medical provider war underway in northern Colorado.

Now that the health care industry has captured a sixth of the nation's economy, fast on its way towards 20 percent, it appears there are sufficient dollars sloshing around inside of the system, so that the real competitive concern is now one of cornering a little more than your fair share of the market. Richard Westfall, the keynote speaker, and an attorney at Hale Westfall, has also served as general counsel to the Colorado Republican Party. Nonetheless, he provided a balanced presentation of the options facing the court, which range, of course, all over the map. His observations on the "severability" question were intriguing, as he pointed out that it would be easier to simply kill the entire bill than to try and interpret which sections remained operative independent of the individual mandate.

His guess that the White House decided to accelerate the case in order to increase pressure on the court to act deferentially to the wishes of congress may incorporate a partisan slant, but he was supported by Bill Ritter and John Hickenlooper's health care restructuring guru, Joan Henneberry, who speculated that the Democratic campaign will hammer the Supremes as activist judges throughout the fall if they choose to overturn the legislation. Al Gilchrist of the Colorado Medical Society expected the marketplace to continue to demand reforms whatever the outcome of the decision. Patients entering the system today are younger and sicker than ever before, and their costs are being borne by the Colorado businesses still willing to offer health care coverage to their employees. Without a federal solution, he seemed to think that the Colorado Legislature would have to step in, however unlikely reaching a bi-partisan agreement would be.

Daryl Edmonds of the Health Care Consulting Group risked some predictions if the legislation is killed: that insurance sales across state lines, a Republican favorite, will prove legally unfeasible, together with guaranteed issue despite pre-existing conditions; that the age 26 inclusion in parental insurance will survive, as well as the removal of a lifetime cap on claims, with the remainder of the provisions up for grabs. He suggested that a public option would probably re-emerge as an alternative, although Congressional Republicans have already launched an "investigation" of the consumer-driven, Health Care CO-OP awards already funded under the act. Either way, it's safe to predict more policy chaos ahead.

I waited in vain for probing or analytical questions from participants that would reflect profound concerns about the fiscal implications for their business models. There seemed to be more interest in the fact that Justice Scalia said he had no intention of reading all 2,700 pages of the Affordable Care Act, or, that the court might punt the entire question down the road. I couldn't help feeling there was sufficient fiscal grease in the current system so that most of the players can expect to find a way to keep the wheels turning. In fact, there was a whiff of that entitled arrogance one usually finds in meetings with the oil and gas crowd.

That's probably not good news for health care consumers. I'm not sure I know precisely what a specialty hospital is all about, but I won't be surprised when one pops out of the ground nearby.