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Supreme Court

5 hard truths for provider business in a post-Roe America

Authors: Sebastian Beckmann, Miles Cottier, Isis Monteiro, Alex Polyak, Tara Viviani, and Rachel Woods.

On June 24, 2022, the Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and throwing the issue of abortion access and its legality to state-level jurisdiction. Thirteen states had “trigger laws” set to take effect if Roe was overturned, and even more new laws related to abortion access are making their way through state legislatures.

Unwinding a half-century-old framework for medical practice will have implications for every corner of the health care industry. Because providers have some of the largest and most immediate questions, this report focuses on the impact for hospitals, health systems, and physician groups and their leaders.

Many providers have not felt pressure to declare a public position on abortion – either politically or through offered services–because in many markets alternatives were available. Most large health care institutions left elective abortion care to independent abortion care providers, who deliver the vast majority of abortions in the United States. The temptation to continue to fly under the radar is understandable, especially when it may feel like it is a no-win proposition to engage in a heated political environment. However, with Roe eliminated, the real-world consequences of policy change on clinical workflows and employee engagement cannot be avoided.

We’ve outlined five hard truths about restricted abortion access and how it will impact provider businesses. Though some of the recommendations below may apply to other organizations, we plan to publish more in-depth work on how this will specifically impact other sectors of health care.

In this report, we share the consequences of inaction, offer action steps to mitigate those business risks, and share implementation guidance to help leaders navigate an uncertain moment for the health care industry.

5 hard truths for provider business in a post-Roe America

Hard truth 1: You need to plan for more than just your balance sheet.

  • Action step: Watch for shifts in volume, payer, and case mix, but focus efforts on the hidden costs that present more serious near-term business risk.

Hard truth 2: Your workforce and patients will demand clarity on how you’re responding (whether you want to share it or not).

  • Action step: Provide immediate emotional support to your workforce.
  • Action step: Create a single source of truth for patients and consumers.

Hard truth 3: You’re facing legal uncertainty—and it’s going to impact your staff in more ways than one.

  • Action step: Constantly ensure the workforce is aware of new (and changing) legal realities.
  • Action step: Adapt clinical and operational pathways in accordance with new policies.

Hard truth 4: You need to update your workforce policies—and they’ll likely need to keep evolving.

  • Action step: Craft a benefits policy to address the geographic implications of Dobbs v. Jackson on each facility in a way that reflects your mission and keeps you competitive as an employer.
  • Action step: Address the implications of restricted abortion into professional development strategy.

Hard truth 5: You’re going to face growing demand for women’s health care—while OB economics deteriorate.

  • Action step: Critically evaluate obstetrics unit finances and proactively plan for gap-filling services.
  • Action step: Support holistic women’s health across all service lines.
  • Action step: Address the root causes of maternal health inequities.
  • Hard truth 1: You need to plan for more than just your balance sheet.
  • Hard truth 2: Your workforce and patients will demand clarity on how you’re responding (whether you want to share it or not).
  • Hard truth 3: You’re facing legal uncertainty—and it’s going to impact your staff in more ways than one.
  • Hard truth 4: You need to update your workforce policies—and they’ll likely need to keep evolving.
  • Hard truth 5: You’re going to face growing demand for women’s health care—while OB economics deteriorate.

In a highly regulated industry with an emphasis on compliance, it is only natural that the legal uncertainty and complexity unleashed by the Supreme Court ruling would be unsettling for employees and leaders alike. The business challenges we highlight in this report are not comprehensive, but they are the clearest at this early stage and the most urgently faced. They will certainly be difficult to “get right” in a way that satisfies everyone. Health care leaders must choose this moment to communicate more, listen more, measure more, and self-examine more than they would normally do. That is the path to better engagement and better results for your business, your people, and your patients.

Chloe Bakst, Darby Sullivan, Kara Wall, Joel Whitaker, and Rachel Zuckerman contributed to this post.

More on the fall of Roe v. Wade

In addition to the business implications for all health care stakeholders, we are researching how to support the clinical workforce, and the impact on pregnant patients and their families.

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