As the presidential election heats up, the Supreme Court's landmark 5-4 ruling on the Patient Protection and Affordable Care Act already seems like ancient history.

The court's June 28 decision to uphold the insurance mandate but leave Medicaid expansion up to the states answered some questions about uncompensated care and raised others. And many of those issues are likely to remain in the air as health care plays a starring role in the campaign themes of both political parties this fall.

It's not unfamiliar territory for health care organizations. In fact, it's hard to remember a time when health care providers weren't subject to uncertainty emanating out of the national and state capitals. That is why such external factors likely will take a back seat to the hard work of transforming the health delivery system.

With hospitals and health systems in many cases targeting 20 percent reductions or greater in their cost structures, it is essential that they continue to stress lean operations and high-quality results. If anything, the reimbursement changes being driven by health care reform are making this journey even more important.

Efficiency gains and verifiable cost savings long have been the primary goals of Health Facilities Management's audience. In fact, we spend a good chunk of our monthly editorial lineup and practically all of our December "Trends" issue providing information exclusively on those two topics as they relate to design, construction, operations and maintenance.

That these priorities are now clearly shared by hospital administrators and the overall health care industry should give our readers some encouragement. But it should also provide them with a constant reminder that the pressure is on to deliver favorable results.