Local reaction to the U.S. Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act was mixed Thursday, as North Texans tried not only to understand the decision but also how it will affect their lives.
Confusion swirled after early news reports from two cable television channels jumped ahead of blog reports coming from court observers, claiming the individual mandate to purchase insurance was struck down.
The Supreme Court did not have the support of enough justices to uphold the individual mandate through the commerce clause of the U.S. Constitution — that Congress could require individuals to purchase health insurance through its power to regulate interstate commerce. However, Chief Justice John G. Roberts Jr. sided with four of the justices to uphold the mandate through Congress’ taxing authority.
During a media call Thursday morning, Texas Attorney General Greg Abbott called such use of taxing authority “novel.”
“This decision caught both sides by surprise today,” said Abbott, who was in the chambers when the justices read the decision.
Texas officials will have to work swiftly to determine what is needed to comply with the law, Abbott said, even as attorneys in his office continue to review the law for other possible constitutional challenges.
It was unclear, for example, whether the state would have to create a health insurance exchange, a place where Texans can obtain low-cost health insurance.
“How that will all work, we don’t know yet,” Abbott said.
Louisiana, Maine and New Hampshire have all decided not to establish exchanges, according to the latest report from the Kaiser Family Foundation, which is tracking the law’s implementation. Thirty-four states have either established exchanges or are moving toward it. Texas is one of 14 states that have done nothing to meet the requirement. When passed in 2010, the Patient Protection and Affordable Care Act provided for the federal government to set up a health insurance exchange if a state does not.
Barclay Berdan, chief operating officer of Texas Health Resources, said Thursday’s ruling facilitates health care in some ways and raises questions in others.
“The Medicaid mandate was not upheld — the part where the states needed to comply in order to get Medicaid funds,” he said. “The federal government will have to figure out now how to work with states, when they don’t have the ability to compel them to comply.”
Overall, however, Berdan said the ruling was the best possible outcome, since many health care providers and systems are already far down the path of reform.
“We think reform happens locally and we have to lead at that level,” Berdan said.
The ruling could help small health care practices, too, according to Dr. Irwin Segal, a family practitioner in Plano, particularly in getting people health insurance coverage.
Seeing people lose coverage because they got sick, or couldn’t get coverage because they had a pre-existing condition, has been a huge problem in the American health care system, said the Canadian-born and trained physician.
Having children stay on their parents’ health care plan until age 26 does more than help young people, who seem to be taking longer to establish careers and become independent, he said.
“You get more young people in the plan and that widens the risk pool, reducing costs for everyone,” Segal said.
But he remains concerned that the law itself is too complicated and favors big hospital systems and doctors’ groups. He continues to doubt large groups can deliver care more cost effectively than primary care physicians and small family practices.
“We saw HMOs [health maintenance organizations] come and go,” Segal said. “In the future, I think we’ll see that accountable care organizations aren’t saving anybody money, either.”
The growth in uninsured and under-insured patients necessitated health care reform, although Caleb O’Rear, CEO of Denton Regional Medical Center, said Thursday’s Supreme Court ruling will have minimal effect on hospital operations.
“Regardless of one’s political affiliation, I believe it to be an embarrassment that in our state alone, 26 percent of the population is currently uninsured, including more than 1.2 million children,” O’Rear wrote in an e-mail.
The 2,000 patients of Health Services of North Texas — which received a $595,833 grant and became a federally qualified health center through the new law last week — will continue to be served, said the center’s director, Ron Aldridge.
“There is a lot of adjustment that needs to be made; both Republicans and Democrats have said that before,” Aldridge said.
U.S. Rep. Michael Burgess, R-Lewisville, said he was surprised by the court’s decision. During a phone interview Thursday, he recalled Justice Roberts asking a few questions about taxation in the law during oral arguments in March. For whatever reason, his questions did not signal to Burgess and other court observers that Roberts, and not Justice Anthony Kennedy, would be the pivotal vote.
“The questions he was asking seemed for completeness’ sake,” Burgess said.
In the coming weeks, Burgess sees Congress turning its attention to the taxes that remain a part of health care reform. Twenty-one of the 23 taxes signed into law with the reform are still in effect and need to be addressed to curb the burden on the American people, he said.
“The smart money says that’s the next activity we’ll be seeing, legislatively,” Burgess said.
Politically independent, John Baines wasn’t concerned about how the new law and the ruling would affect his small Denton accounting firm.
He called the Patient Protection and Affordable Care Act a “good first draft” of what the country needs to address the problem of access to affordable care.
“It might need some tweaking,” Baines said. “I find it’s always best to do what’s right for the most people. We don’t need to do things for small groups to be placated and satisfied.”
Staff writer Britney Tabor contributed to this report.
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BY THE NUMBERS
More than 160 Denton Record-Chronicle readers responded to our health care survey. The survey was placed on our website — DentonRC.com — and our Facebook page and Twitter accounts.
Do you agree or disagree with the decision to keep the individual mandate to purchase health insurance?
• Agree: 55%
• Disagree: 45%
Do you agree or disagree with the decision to uphold the entire law?
• Agree: 56%
• Disagree: 44%
Will this decision make it easier or harder for you and your family to pay for health care?
• Easier: 55%
• Harder: 45%
Do you have health insurance?
• Yes: 91%
• No: 9%
Where do you live?
• Northern Denton County: 62%
• Southern Denton County: 38%
SOURCE: U.S. Supreme Court decision survey conducted by PollDaddy.com