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Local leaders debate ACA ruling’s impact

June 28, 2012


State and local leaders continued to digest the impact of the Supreme Court’s ruling Thursday that most of President Barack Obama’s health care reforms are constitutional.

Although Obama’s Affordable Care Act passed the high court’s review, Republicans across the nation are setting their sights on repealing the measure by urging their supporters to the polls in November.

The Supreme Court upheld most of the health care legislation, including a coverage mandate which affects most Americans, Thursday in a 5-4 decision. Chief Justice John Roberts broke from the court’s conservatives and joined Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor for the majority decision.

While Roberts said the mandate was an example of Congress’ ability to lay and collect taxes, dissenters said the law “exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding.”

GOP legislators from Mississippi’s congressional delegation all joined together to denounce the law and the ruling.

U.S. Sen. Thad Cochran, Rep. Alan Nunnelee and Rep. Gregg Harper all issued such statements Thursday, while U.S. Sen. Roger Wicker called the president’s policy significantly flawed and a major tax increase. Harper said a vote for repeal could happen as early as next month.

OCH Regional Medical Center Administrator Richard Hilton said the politics of “Obamacare” do not interrupt the hospital’s primary goal: providing health care to area residents.

Under legislation guidelines, Hilton said approximately 500,000 additional Mississippians would gain insurance coverage as more provisions are enacted over the next few years. The act, he said, could increase the amount of patients seen by private practice and county health employees.

“This means a new source of coverage for the uninsured; however, if they cannot get into a doctor’s office or if a doctor is no longer taking new patients, the responsibility falls back to the hospital,” Hilton said. “I believe our community doctors will do the best they can to see as many patients as possible in order to provide accessible care. OCH will be the safety net when there are not enough primary providers to accept new patients.”

No changes will be made to OCH’s pricing, Hilton said.

“The Affordable Care Act is not designed to be production/volume ... driven; it’s geared toward more value-based purchasing where you have to provide care, do it efficiently and have measurable results,” he said. “The better quality results you have, the better (reimbursements) will be.”

The American Hospital Association supported the Affordable Care Act, Hilton said, and agreed to help by accepting $155 billion in decreased reimbursements for a 10-year period. In return for the caveat, he said, more people would have insurance coverage and hospitals would have to write off less bad debt.

“For the consumers, … their concern is coverage of benefits, pre-existing conditions, co-payments and how much premiums they have to pay. Going forward, those elements are really the same for what it’s been for past 50 years. Every year, people are trying to have health care covered,” Hilton said. “For providers, the concern is how are the hospitals and providers going to change proactively in order to provide quality care with less reimbursement, make (it) affordable and have accessible health care available (while) working to remain financially viable.

“For the state of Mississippi, the concern coming out of Supreme Court ruling … was regarding the Medicaid population and expanding the program. About 350,000 Mississippians are additionally eligible for Medicaid (under the health care act). The court said the expansion could proceed, provided the federal government does not threaten to withhold a state’s Medicaid allotment if it does not participate in the eligibility expansion,” he added. “This provision was not anticipated by anyone, and it has major possible ramifications for our state’s Medicaid program and for our state legislators to fund the program.”

As the health care industry anticipates the start of many of the act’s provisions, many Miss. GOP legislators said they were surprised at Thursday’s court decision.

“There’s no doubt this law is not good for the citizens of Mississippi. It’s clear you couldn’t find five votes to agree an individual mandate was lawful, so they had to find a different way and say it was a tax. I remember when the president said it wasn’t a tax,” Harper said. “There are so many problems with this bill, from creating independent advisory boards authorized to approve care to cutting benefits by over $500 billion. It certainly reduces our individual freedoms because now we’re told something we have to do. You could argue it taxes inactivity; this is unusual in many regards.”

“I’ve already voted in excess of 30 times to defund or repeal ‘Obamacare.’ It’s a bad law and deals a serious blow to liberty,” Nunnelee said. “The foundation of our government just does not rest on ‘We, the Supreme Court;’ instead, it rests of ‘We, the people.’ We will have our say in November.”

Calls to U.S. Rep. Bennie Thompson, the state’s only Democrat in the U.S. House of Representatives, went unreturned as of press time.

Miss. Rep. Gary Chism, a Republican, said funding for education, infrastructure and other major state projects could be in serious trouble once additional Medicaid coverage is forced.

“When (the Supreme Court) said (the government) could require a mandate, it was just a real shock to me,” Chism said. “I think the entries into the Medicaid rolls are going to break the state. I’m afraid there will be less money for education in the future and (the health care legislation) will suck up all of our funding.”

The majority decision precluded the federal government from threatening the funding of existing Medicaid programs in states that refuse to comply with the Medicaid expansion dictated in the ACA.

Miss. Rep. Steve Holland, D-Plantersville, said the Supreme Court made the correct decision from a constitutional law perspective.

“I’m glad they left some provisions to the state on Medicaid, but we’re going to have somewhat of a struggle in Mississippi because of what’s left up to the Republicans,” he said. “It’s time the country moves on in individual states with the full enactment. This Democrat believes really and truly that every citizen has a right to health care. The richest nation in the world should be able to do that for its citizens.”

No matter if ACA is repealed or remains the nation’s main health care law, Hilton said true reform will still be needed as health care evolves.

“Going forward, providers are going to have to react differently to the future of health care and deal with changes to survive. That is the challenge we face,” he said.

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