“The system is broke,” said Spencer Brewer, the owner of Lavender Mountain Hardware, 4065 Martha Berry Highway. “Whether this is the fix, I don’t know. We’ll just have to wait and see.”
Brewer, who offers an insurance package to his 15 employees, said it appears that even the most informed people in Congress don’t know what the law is ultimately going to do, whether there will be better health care services, what direction prices will go. It’s all still a guessing game.
Redmond Regional Medical Center CEO John Quinlivan said he expects some changes.
“If the Republicans are elected, I’m not sure what might change. I don’t think it would all be thrown out, that would be really hard to do,” Quinlivan said.
GOP presidential hopeful Mitt Romney was quick to the podium Thursday pledging to repeal the law on his first day in office if he is elected.
A full day after the majority ruling, penned by George H.W. Bush-appointee to the court Chief Justice John Roberts, health care officials, insurance executives and business leaders are still poring over the 193-page document.
Harbin Clinic President Dr. Ken Davis said he would prefer to withhold comment on the ruling until he had a chance to give it a thor-
ough review. “At this point I would rather wait until I get a better understanding of the ruling before making further comment,” Davis said.
“From what I’ve read, this doesn’t change anything as far as the small employer tax credit; it doesn’t change groups over the size of 50 being required to offer health insurance, as far as what’s going to happen in 2014,” said Chuck Shaw, vice president for employee benefits at Garner and Glover Insurance, 135 E. Eighth Ave.
What did change, rather dramatically, was the interpretation of the court that the individual mandate requiring health insurance, while not permissible under the commerce clause of the Constitution, could be imposed as a form of tax.
Quinlivan said the individual mandate was what created the financing mechanism for the whole deal. “It creates the resources with which to expand coverage and so, the fact that it was upheld, in kind of a different way, at least means there should be money to fund the program,” Quinlivan said.
Until Justice Roberts’ decision was made public, the law itself called it a “shared responsibility payment.”
“In 2016, for example, the penalty will be 2.5 percent of an individual’s household income, but no less than $695 and no more than the average yearly premium for insurance that covers 60 percent of the cost of 10 specified services,” reads Justice Roberts’ decision.
A part of upholding AFA means that beginning in 2014, the ability of insurance companies to refuse to cover pre-existing conditions goes away.
“That’s what the insurance carriers are afraid of,” Shaw said. “How do we price that? How do we keep them from going to purchase a policy on the way to the emergency room? How do we keep those things from happening.”
Pricing is one way the insurance companies can deal with that issue. Shaw suggests that if 50 million Americans are forced into the the system, with no pre-existing conditions, “they can’t charge any of us enough to cover the cost of that.
“You get a policy for two months, and you’re having whatever type of surgery, then drop it two months later; that’s a lose-lose,” Shaw said. He predicts there will be discussions between the private sector and government before that provision of the law goes into effect in 2014.
Businessman Brewer is a little worried about the quality of care under the Obama law.
Quinlivan said, at least in theory, with more people having access to care that there might be some issues with capacity demands. “There may be challenges in terms of numbers of physicians,” Quinlivan said. “We’ll probably continue to see additional physician-extenders and non-physician providers particularly in primary care.”
Floyd Medical Center CEO and president Kurt Stuenkel said part of health care reform addressing quality issues is already in play. “The federal government over the last several years has been putting in systems that would both measure and reward quality, and measure and reward improving levels of patient experience,” Stuenkel said. “Those are some appropriate things that are already in health care reform.”
Stuenkel is concerned, along with many others in the health care industry, that providers are put in a position of seeing more coverage but at lower rates of reimbursement.
Quinlivan pointed out that there would be a Medicare payment advisory committee that is now going to be empowered to ultimately cut rates if costs do not come in line. “Ultimately they’ll be able to enact rates that would be lower,” Quinlivan said. “That is of concern to hospitals and health care providers, that ultimately you have this bureaucratic body that would be empowered to reduce your reimbursements; it could be arbitrary if certain numbers are not hit.”
The number that business owners, particularly small business owners like Brewer, are most concerned about is those bottom line figures.
“I hope the cost of care does not increase. It can’t keep going up,” Brewer said. He estimates that the cost of providing health insurance for his employees runs at about 30 percent as compared to payroll expenses, and not all of his 15 employees take advantage of the benefit.
At what point could Brewer see himself dropping health care?
“We’re almost to that point right now,” Brewer said. “We actually considered this year saying, OK, you’re on your own, we will provide you “x” amount of dollars, but we didn’t figure we’re to that point yet.”
“I was talking to Virginia (Brewer, his wife) at lunch, we just said we’ll just see what happens, how it comes down the pike,” Brewer said.
That’s about all anyone can do at this point. The election in November could change everything, or not.
Previously posted WASHINGTON — The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.
The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
John Quinlivan, CEO of Redmond Regional Medical Center said the ruling in effect means the health care act will proceed as envisioned.
"What I gather is that they said under the commerce clause, the government cannot force you to enter the stream of commerce so that they can regulate you. That was the issue. The government is telling you you must buy insurance and because you buy insurance we can regulate that. They would be forcing you to enter the stream of commerce. You can't do that. They can regulate you once you're participating in it, but they can't force you to enter it. What the Supreme Court said is right, that would be unconstitutional under the commerce clause but the government does have the power to tax, so viewed as a tax, this is constitutional. I think that's probably a creative and correct interpretation. It means that Obamacare is going to happen just as it was envisioned and structured and we'll see how it works."
Kurt Stuenkel, CEO and President of Floyd Medical Center said it appears the law remains largely in tact.
"The mandate is in place and apparently the rest of the law is going to remain largely in tact. We here at Floyd have been working for the past couple of years with the regulations as they have been unfolding so we'll just continue down that path. Unless Congress makes some changes in ensuing months and years."
At this point many, including the higher ups in local hospitals and insurance companies, don't fully understand what the ruling means.
"I don't think any of us can intelligently comment," said Dr. Ken Davis President and CEO of Harbin Clinic. "My understanding is confusing at this point especially as it relates to the penalty for not buying insurance and at this point I would rather wait until I get a better understanding of the ruling before making further comment."
Chuck Shaw the vice president of employee benefits for Garner and Glover Insurance said while the law has been upheld, he's not sure this is what President Obama wants.
"Under the taxation it's approved, but as part of the commerce clause it's not, so what I'm thinking is it's an individual mandate, if it's not commerce, how are they going to tax it?", said Shaw. "Yes, Obama can say it's been approved but is it all that they wanted? This may make it more difficult for President Obama to even tout it if you can't enforce it, exactly."
Click here to visit the RN-T.com POLITICS page and see reactions from local and state lawmakers.
Chief Justice John Roberts announced the court's judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.
The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.
The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.
The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.
Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.
"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenters said in a joint statement.
- Click here to read "A reader’s guide to health care ruling" from the SCOTUSblog for information on how to read the ruling.