In the wake of the U.S. Supreme Court’s momentous ruling on the federal health care reform law, Flathead Valley health care officials offered reactions varying from uncertainty to excitement, with some saying the law is a positive step forward for rural health care.
On June 28, the Supreme Court ruled 5-4 to uphold the cornerstone of the Obama Administration’s Patient Protection and Affordable Care Act (ACA): the individual mandate requiring Americans to obtain health insurance or pay a penalty. The court largely upheld the law as a whole, though the justices ruled 7-2 that states can’t be coerced into participating in a large expansion of Medicaid.
The ruling, both in its implications and its actual page heft, was a lot to digest and late last week Flathead health care officials were still trying to wrap their heads around it.
Jim Oliverson, senior executive director of Kalispell Regional Medical Center, said the hospital’s legal counsel was poring through the decision. Oliverson talked about the importance of digging into the law itself as well.
“It’s so big and there are so many pages in the law,” Oliverson said. “The devil’s in the details. Right now, there are just a whole lot of unknowns.”
While unknowns remain, the ruling did provide a degree of certainty by answering significant legal questions and giving the health care industry the green light to move forward with fully implementing the law. Since the Affordable Care Act was approved in 2010, the health care industry has already been implementing parts of the law.
“For us it’s almost a non-event in that it didn’t change a lot,” Jason Spring, CEO of North Valley Hospital, said. “We’re glad to have clarification and moving forward we will continue to provide the same quality of care in our community.”
Spring’s comments echoed the official statement from the Montana Hospital Association.
“The ACA holds the promise of providing health care coverage to thousands of Montanans currently uninsured as well as to making the delivery of health care more cost-effective and efficient,” the association said.
Yet uncertainty will persist at least through the November elections, with Republican presidential candidate Mitt Romney vowing to repeal the law if elected and Congressional Republicans making their own vows.
In a statement following the Supreme Court ruling, Montana Congressman Denny Rehberg said “this fight is a long way from over because the Constitution gives final authority to We the People on election day.”
“Every time they convene a session,” Spring said, “we assume there’s going to be something that’s going to change and I assume we are going to see many political battles ahead.”
“I don’t think it’s ever going to be really done,” he added. “It will be constantly evolving.”
Spring believes the law is a positive step forward for the health care industry. More people will be covered by health insurance, which he said is a “good thing for our community.”
“Health care reform has a lot of positive aspects for us as a hospital and for rural health care,” he said.
Jay Erickson, the past president of the Montana Medical Association and a physician at Glacier Medical Associates in Whitefish, is also pleased by the prospect of expanded coverage. He was “excited and optimistic” about the Supreme Court decision, while acknowledging there is a “wide variety of opinions” on the law’s benefits among physicians and other health care professionals.
“The Affordable Care Act is not a perfect solution to what ails our health care system, but it’s a start,” Erickson said. “I’m a real advocate for coverage. I think that as a society we understand our system needs to be fixed.”
Based on the court’s ruling, Erickson said it will be up to the Legislature to decide if Medicaid is expanded in Montana as outlined in the federal law. In Montana’s GOP-controlled Legislature, the odds are not in favor of expansion.
Erickson believes that a vote against Medicaid must be accompanied by an alternative solution. He pointed out that the last Legislature opted against creating a state insurance exchange and now is forced to let the federal government implement its own exchange in Montana.
In addition to his role at Glacier Medical Associates, Erickson is the medical director at Shepherd’s Hands Free Clinic and assistant dean for the University of Washington School of Medicine’s WWAMI program in Montana.
“People have to be covered and if they’re not going to be covered through Medicaid how are we going to cover that group of citizens?” he said. “If we decide not to participate I think we need to have a viable alternative to cover those people.”
Insurance companies are generally considered to be on the losing end of the Supreme Court’s decision, though Tanya Ask, vice president and external relations for the Helena-based insurance provider New West Health Services, isn’t too worried.
Ask said her company, which is transitioning into the Medicare market, has already traditionally practiced some of the law’s requirements, such as preventive services without out-of-pocket costs for members. And because the law was passed in 2010, New West has been implementing a number of its other provisions.
There have been concerns cited over the law’s impact on Medicare and especially Medicare Advantage funding, but Ask said the funding modifications predominantly impact urban places in states such as Florida, California and Texas.
“That’s one of the benefits of being in a rural state,” she said. “We do not view the law as negatively affecting our ability to provide good Medicare Advantage service.”