Last month, the Supreme Court of the United States brought to an end a contentious legal battle over the constitutionality of the Patient Protection and Affordable Care Act (ACA), the health reform law passed by Congress in 2010. It’s reasonable to expect that debates over the wisdom of this law will continue.

The new law has some real benefits, especially for students and other young people.

It now allows those with no other coverage to remain on their parents’ plans through to age 26 and requires insurance plans to cover vital preventive services. By 2014, it will prohibit discrimination based on pre-existing conditions and chronic illnesses and provide financial support for low-income people to obtain health coverage.

Beginning in that same year, each of us who has an income above the poverty level will be required to either purchase health insurance or pay a penalty at tax time.

Of note, the decision also allowed state government to opt-in or opt-out of expanded Medicaid coverage expectations as provided in the original legislation.

But the real battle ahead is not about insurance mandates or which specific drugs or services will be covered by any health plan. It’s a larger and more important question: How can we keep people healthy and reduce the financial burden that health care places on our families, our local, state and federal governments, and our entire economy?

The United States is, increasingly, a nation of unhealthy people. Compared to other industrialized countries we have a high infant mortality rate, are more likely to be obese, and are substantially more prone to heart attacks, diabetes, stroke and respiratory illnesses.

It’s not that we are unwilling to spend money on health. As a nation, our health care spending far outpaces other countries, like Japan or Great Britain, with similar resources. But we don’t get the same bang for our buck.

Much of our current health care payment system is replete with economic incentives that reward providers for doing more procedures or episodes of care.

We do not reward individuals or providers who employ preventive measures that could help many reduce or avoid illness in the first place.

Simply stated, whether you agree with the Supreme Court’s decision or not, our health care system needs to reform. In my opinion, the current rate of health care cost inflation will bankrupt us in a generation if we do not address the underlying health issues facing us as a society.

Without a major change in our nation’s health care system, we’ll be spending 25 percent of our entire economy on health care by 2025 and nearly half of everything we produce by 2082. That is unsustainable. The next phase of health reform must begin to tackle the question of escalating costs.

The 2010 ACA pushed the nation in the right direction of ensuring, to the degree possible, everyone has access to health insurance.

ACA also contains provisions designed to help change how we deliver health care in the United States through the establishment of accountable care organizations, and rewarding providers and health systems for patient outcomes and quality.

The implications for WVU and WVU Healthcare are enormous. We recently created a School of Public Health to train more students in the skills needed to develop healthy communities.

Along with partners across the state, we developed a clinical and translational science institute to bring health research into communities across West Virginia.

WVU Healthcare and our affiliates, which provide tens of millions of dollars in uncompensated care to people without insurance, will be challenged to reorient themselves to having more accountability for health outcomes and seeking ways to deliver cost-effective care.

The debates are not done. While upholding the major provisions of the ACA, the Supreme Court simultaneously pushed health care reform back into the political process.

That being said, it is time for us to hunker down and focus on the work ahead.

Christopher C. Colenda has served as Chancellor for Health Sciences at WVU since 2009.

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