Saturday, December 20, 2014 · 2:17 a.m.
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More reading on health care reform 

Click here for an article about a Vanderbilt poll about what state residents think about the Affordable Care Act.

—Click here for five falsehoods about the health care law from PolitiFact.com.

—Click here to see what the health care law means for individuals.

—Click here to read the Supreme Court decision.

—Click here or here for more reading on the topic—from the New York Times and the Associated Press, respectively—and here to access the Supreme Court of the United States blog chat. 

After some confusing national news coverage on a complicated topic, made more muddled by social media explanations, leaders reacted to the Supreme Court ruling that the core of President Barack Obama’s health care reform act is constitutional.

Both the Tennessee Medical Association and the National Federation of Independent Business sent out statements on the issue.

Leaders with BlueCross BlueShield of Tennessee said Thursday that they have “long advocated for health care reform” but that there is still work to do on the law.

And Erlanger leaders said at a Thursday night board meeting that the change might first mean more uncompensated costs for them but ultimately will help their bottom line.

The ruling, the impacts
Thursday’s 5-4 decision means that the president’s Affordable Care Act will continue to be implemented over the next few years.

It means that many of the 30 million uninsured Americans will have to buy health insurance.

Those who don’t will have to pay a “shared responsibility payment” to the federal government, according to the ruling.

Quotes

—"There are no clear winners and losers."

—"From the individual consumers' perspective, it's good that you can't be turned down for pre-existing conditions, and you can't be charged a higher premium for having a pre-existing condition." 

Source: April Wortham, market analyst with HealthLeaders-Interstudy

The ruling also impacts the way states implement Medicaid, according to the Supreme Court of the United States blog.

The Medicaid expansion decision allows states to opt out of expanding Medicaid, but if they do, they could lose some federal funding. But justices said the federal government isn’t allowed to withhold all Medicaid funds.

“It let it up to the states to decide,” April Wortham, market analyst with HealthLeaders-Interstudy, said. “They won’t take the money they are already giving you, but if you do expand, [they] will give you more money to help you.”

If Tennessee leaders chose not to expand Medicaid, it could still leave providers “in a pinch,” she said.

“The bottom line is, providers are going to be really looking now to the state capital to see what they decide on Medicaid,” she said.

The ruling also bans excluding people with pre-existing conditions from coverage, eliminates annual and lifetime limits on health benefits, and allows young adults to stay on their parents’ insurance programs for longer.

Obama addressed the country Thursday and called the decision a victory for the American people.

He didn’t fight for the law because it was good politics, he said.

“I did it because I believed it was good for the country,” he said.

The ruling affects everyone in the health care industry, Wortham said.  

“Everybody up and down the entire health care spectrum will be impacted,” she said.

When the law passed in 2010, it meant more customers for health care providers, she said.

People who hadn’t previously been insured became paying customers, which cut down on uncompensated care costs—cases in which a patient can’t pay, so a hospital eats the expense of treating them.

Twenty-somethings who wouldn’t otherwise have coverage could be covered under their parents' insurance, for example.  

Erlanger
Wortham said that, so far, the ruling seems to be good for hospitals, but health care provider leaders will be interested to hear what state legislators will do about the Medicaid issue.

Erlanger CEO Charlesetta Woodard-Thompson said that before the law goes into effect in its entirety, there may be more of a cost burden on the hospital.

This year, Erlanger paid for more than $90 million of uncompensated costs, leaders said.

But the hospital could benefit from Medicaid funds, and, overall, the high court’s constitutional affirmation is good for the health care system, CFO Britt Tabor said.

“In the end, those charity cases or indigent would actually be compensated at a particular rate,” he said. “Overall, I think it is a positive for Erlanger, but think the devil is sort of in the detail on how to carry this out, very similar to when we moved from a traditional Medicaid program to the TennCare program within the state of Tennessee.”

BlueCross BlueShield
“From an insurance perspective, they’ve got to be cheering the fact that the individual mandate is upheld,” Wortham said.

Insurance provider BlueCross BlueShield has been working to implement the law since it passed in 2010.

“We recognize people want and need affordable health insurance, and the law helps expand coverage to thousands of our fellow Tennesseans,” BlueCross spokeswoman Mary Danielson said in an email Thursday. “That’s a goal we believe in and one we’ll continue to support by implementing the law in a manner that best benefits our members and the state.”

In April, Tony Hullender, senior vice president and general counsel for BlueCross BlueShield of Tennessee, said that if the high court struck down the individual mandate, it would mean higher insurance premiums and a destabilization of the entire market.

But Danielson said there are still parts of the law that will raise premiums and disrupt the market, so BlueCross leaders are going to work with policymakers to change those portions.

“Working with policymakers and other Tennessee health care leaders, we’ll also continue to push toward delivery-system reforms and solutions that reduce costs and improve quality,” she also said.

Wortham said that the change will mean that insurers will have to provide expanded benefits, and that means additional costs.

So there will be higher insurance premiums, she said.

“But at least they aren’t faced with the situation where people wait until the last minute, until they are very sick [because they don’t have insurance],” she said.

Additional reactions
But leaders with the Tennessee Medical Association still have concerns, according to a statement.

“Physicians remain concerned about the lack of efforts to reduce wasteful hassles and regulations, the creation of an unaccountable dictatorial oversight board, lawsuit abuse, the unwillingness of Congress to fix the Medicare fee schedule for physicians, the limited supply of physicians to care for an expanded patient base, and the rights of patients to choose who provides their medical care,” according to the statement.

Northwest Georgia resident Lara Hayes, a breast cancer survivor who is now fighting kidney disease, said via Twitter that she is concerned about the country’s ability to pay for the reform.

She thinks it means health care will be rationed.

“Being forced to pay a tax to cover others’ coverage that I myself will be denied is not right,” she said. “This law is for those from 18 to 40. If you're not in that age group, then your life won't matter. [It’s] all based on cost. People’s lives will be determined on cost and their potential contribution to society.”

But according to PolitiFact.com, which has monitored claims made by supporters and opponents of the Affordable Care Act for several years, statements that health care reform rations care, denies treatments and creates death panels are false.

Officials with the National Federation of Independent Business said they are disappointed with the outcome and that the president broke a campaign promise in this situation.

"We are concerned about the precedent that this will set in Congress’ ability to mandate other aspects of our lives, but we will move forward from today to continue to fight, harder than ever, for real health care reform for our membership,” according to a statement.

The federation’s leaders said they will fight to repeal the law.

“Under the health care law, small business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses,” also according to the organization’s statement.

Wortham said that for business owners, the decision at least brings some finality. For the past couple of years, business leaders have been implementing a law when they weren’t sure if it would be upheld.

“If I’m an employer, it brings a lot more clarity to the situation,” she said. “They have been in limbo for two years.”

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