Health care ruling ignites firestorm of debate

Friday, June 29, 2012

By James R. Campbell

Nevada Daily Mail

The U.S. Supreme Court's landmark Thursday decision to uphold most of the 2010 Patient Protection and Affordable Care Act, or "Obamacare," was lauded in some quarters across Missouri as generally beneficial to health care, but it was heavily criticized in others as an abridgement of American freedoms.

Statements were issued by Nevada Regional Medical Center, the National Rural Health Association, Gov. Jay Nixon, U.S. Rep. Vicky Hartzler, R-Harrisonville, Missouri Health Advocacy Alliance, Republican state senate candidate Ed Emery of Lamar and the National Federation of Independent Business.

NRMC Chief Executive Officer Judy Feuquay expects to be conveyed a lot of information in the ruling's aftermath.

"We await further clarification of what the Affordable Care Act means to Nevada and we will receive frequent updates through our partners at the Missouri Hospital Association," Feuquay said in a news release.

"This is inspiring for our rural community. We await a complete analysis of the information. In the meantime, we will continue to provide quality health care to our patients and community, as we always do."

The NRHA said Obamacare has some positive aspects.

"Whether you support or oppose the health care bill, it is important to know that many provisions were included that benefit both the rural provider and patient," a news release said.

"During the health reform debate, NRHA's position was clear: improve rural America's access to health care providers by resolving the workforce shortage crisis in rural areas and eliminate long-standing payment inequities for rural providers."

Nixon, a Democrat seeking re-election this year, said state leaders "are just now beginning to review this ruling so we can understand exactly what it means to Missouri.

"It has significant complexities and implications for families, health care providers and insurers," Nixon said. "Here in Missouri, I'm committed to working collaboratively with citizens, businesses, medical providers and the legislature to move forward in a way that works best for families in our state."

Hartzler, also running for re-election, said Obamacare "still fails to address the issue of adequate funding and it will drive up health care costs, making it harder for small businesses to hire workers."

Referring to the high court's narrow 5-4 majority, Hartzler said, "While the ruling is cause for dismay, supporters of the free market and individual liberty can take some comfort in the dissenting view that this law violates the U.S. Constitution."

The congresswoman said that since coming to Washington 1-1/2 years ago, she has voted 30 times to repeal, defund or dismantle the law. "This ruling highlights the critical need for a Congress and White House committed to refocusing attention on health care legislation that provides affordability, cost transparency and choice for senior citizens while protecting the right of citizens to keep their current policies."

Political observers were quoted in an Associated Press story from Washington as saying the Democratic-controlled U.S. Senate is unlikely to agree with repeal initiatives by the Republican-controlled House of Representatives.

Missouri Health Care Advocacy Alliance Director Andrea Routh of Jefferson City praised the ruling, saying, "Missouri families can live free of the fear that their insurance company will terminate their coverage the minute they get sick.

"Parents will be able to purchase insurance for their children regardless of any pre-existing conditions," Routh said. "Insurers must continue providing preventative services such as colonoscopies and mammograms at no additional cost.

"Contrary to the rhetoric, millions of people will benefit. I am confident that as we move forward, today's ruling will be looked at as a good thing for this country."

Routh said the law, also called ACA, bars insurers from imposing lifetime dollar limits so people with cancer and chronic illnesses won't go untreated; allows parents to keep offspring on their insurance until age 26; and offers help for seniors on Medicare to afford prescription drugs.

Emery said the Supreme Court's 187-page ruling "failed to defend the U.S. Constitution and people from the tyranny of an over-reaching federal government.

"Missourians overwhelmingly rejected Obamacare in 2010 when they passed Proposition C by a 71-percent margin to block the federal government from requiring people to buy health insurance and from punishing those without insurance," Emery said.

Referring to a Republican Party ballot initiative, he said, "The voters will have another chance for their voices to be heard in November on an initiative to prohibit the governor or any state agencies from establishing Obamacare health insurance exchanges in Missouri without authorization from the legislature."

National Federation of Independent Business State Director Brad Jones said his organization "respects the decision to uphold the individual mandate, but it clearly has now become a tax on all Americans and a broken campaign promise from President Obama not to raise taxes.

"Small business owners are going to face an onslaught of taxes and mandates resulting in job loss and closed businesses," said Jones. "NFIB will keep fighting for repeal because only with a full repeal will Congress have the ability to go back to the drawing board and craft real reform that makes reducing costs a No. 1 priority.

"The power and control of health care decisions should be in the hands of the consumer, not the government."

The AP said Chief Justice John Roberts, a 2005 appointee of former Republican President George W. Bush, broke the tie between liberal Justices Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor and conservatives Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas.

The AP said Roberts had announced the judgment allowing Obamacare to pursue its goal of covering more than 30 million uninsured Americans.

Noting Obama expects 4 million people to pay a penalty rather than buy insurance, the news agency said. Roberts "explained at length the court's view of the individual mandate as a valid exercise of Congress' authority to lay and collect taxes."

Although the mandate has been called a penalty, not a tax, Roberts said, "The payment is collected solely by the Internal Revenue Service through the normal means of taxation.

"Because the Constitution permits such a tax, it is not our role to forbid it or pass upon its wisdom or fairness."

The majority decision found fault with the law's expansion of Medicaid but said that expansion could proceed so long as the federal government does not threaten to withhold the entire Medicaid allocation to states that do not take part.

To date, 14 states and the District of Columbia, not including Missouri, have adopted plans to set up health insurance markets, or "exchanges," by Jan. 1, 2014, as specified by the law.

The Medicaid expansion will cover some 17 million people who earn too much to qualify for assistance but not enough to afford insurance. "In this case, the financial inducement Congress has chosen is much more than relatively mild encouragement," said Roberts.

"It's a gun to the head. What Congress is not free to do is penalize states that choose not to participate by taking away their existing Medicaid funding."

Over 80 percent of Americans have health insurance, the AP said, "But for most of the 50 million uninsured, the ruling offers guaranteed coverage at affordable prices.

"Lower income and many middle class families will be eligible for subsidies to help pay premiums. An added safety net for all Americans, insured and uninsured, will be that starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor to charge more to people with health problems.

"Those protections, now standard in most big employers' plans, will be available to all, including people who get laid off or leave a corporate job to launch their own small business. Seniors also will benefit through better Medicare coverage for those with high prescription costs and through no co-payments for preventative care.

"Hospitals, nursing homes and other service providers may struggle once the Medicare cuts used to finance the law start to bite. Illegal immigrants are not entitled to the new coverage and will remain one of the biggest uninsured groups."

The stocks of hospital companies rose after the ruling was announced, but insurance company stocks fell sharply while shares offered by drugmakers and medical device makers dropped marginally, the AP reported.

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