A consulting firm tries to decide what PPACA scenarios might be in the crystal ball. (AP Photo/New York City Opera, Carol Rosegg)

The analysts at Leavitt Partners L.L.C. admit that they are not sure what the future holds for the Patient Protection and Affordable Care Act of 2010 (PPACA), but they are trying to come up with a list of some of the more likely  possibilities.

Leavitt Partners, Salt Lake City, is a health care intelligence firm that was founded by Michael Leavitt, a former Utah governor who served as Health and Human Services secretary under President Bush.

Leavitt, the chairman of Leavitt Partners, is also the chairman of the firm’s “Health Reform Bracketology” team — a panel that is trying to help show what could happen to public entitlement programs, insurance market legal and regulatory changes, insurance distribution, and health care payment and delivery legal and regulatory changes.

The bracketology team is looking at what could happen to the health care system if:

  • Democrats keep the White House and Senate, and Republicans continue to control the House.
  • Republicans win the White House and keep the House, but Democrats keep control over the Senate.
  • Republicans win the White House, keep control over the House, and win control over the Senate.

Leavitt Partners is calling the first situation Democratic gridlock; the second, Republican gridlock; and the third, a Republican sweep.

The firm has been polling a panel of well-known health policy watchers to see how those people think the top scenarios might affect programs, players and health care system rules.

The health policy watchers on the bracketology team are predicting, for example, that, in a Democratic Gridlock Universe, there would be 0% chance of major changes in Medicare getting enacted, 39% of no Medicare reforms becoming law, and a 60% chance of “some reforms” or “little reforms” occurring.

In a Republican Gridlock Universe, there might be an 89% chance of some Medicare reforms being adopted, but still 0% chance of major reforms taking place, according to the health policy panel.

When Leavitt Partners asked the panel about whether the administration would continue to offer states a high level of flexibility in developing health insurance exchanges, or Web-based insurance supermarkets, in various scenarios, 78% said that outcome was somewhat or very likely in a Democratic Gridlock Universe.

Only 18% of the panel members think it would be very or somewhat likely that the administration would create a viable federal exchange in a Republic Gridlock Universe.

But only 22% of the panelists said they think the exchange program would be eliminated in a Republican Sweep Universe; about 67% of the panelists said they think the exchange program would simply be modified, and 84% of the panelists said they think a Republican administration would continue current Obama administration health care reform efforts even in a Republican Sweep Universe.