Health-care providers and patients had a wide range of reactions Thursday to the Supreme Court upholding key elements of the Patient Protection and Affordable Care Act.
Some applauded the promise of wider access to health care, others cautioned about the expanded reach of government. And some cited economic concerns, both for their own practices and for the country at large. The most common reaction, however, was a hesitance to talk about the issue at all amid a sense that there were still too many unknowns.
When the news broke, Golden Bethune-Hill, volunteer executive director at the 19-month-old Community Free Clinic in downtown Newport News, was at a meeting of the Virginia Healthcare Foundation in Richmond, where Gov. Bob McDonnell was handing out Heroes Awards to those working at the state's safety-net providers. The foundation provides funding for the dental program at the clinic, which provides medical services to uninsured people with incomes less than 200 percent of the federal poverty level. "There's a lot to understand," she said. "At this point the community free clinics are committed to being there to provide care in the community. We've demonstrated there's a need and that's our mission. The uninsured will still be needing care." The expansion of Medicaid remains a question in the ruling, she noted.
At the clinic in Newport News, Monique Gibbs, a family nurse practitioner, said, "I was hoping for it. It's very disheartening as a health-care provider to see those with treatable, preventable diseases who do not have access."
In the past year she's seen many patients who have lost jobs and benefits. "We've had an influx of patients who are no longer able to afford premiums, people you wouldn't expect to see here," she said.
For urgent care physician William Robinett, his experiences as an emergency room physician and as a medical director of a free clinic in Norfolk for a decade dictated his reaction. "It's a fairness issue. The really poor have Medicaid, but those in lower socio-economic jobs who are working hard and have no insurance coverage — if they get sick, they're in trouble. We're a wealthy enough nation we should be able to look after those who are working," he said. "I'm all in favor of the Affordable Care Act."
In his own practice, Robinett anticipates it will mean that many who currently self-pay will gain insurance coverage that will also cover prescription costs.
For others, the wider implications of the individual insurance mandate elicited a different response. Jeffrey R. Carlson, a fellowship-trained spine surgeon and president and managing partner of the Orthopaedic & Spine Center group in Newport News, expressed concern about the law's economic effect. "You can't take out the economic issues. One-sixth of the economy is health care. To impose a tax on the population, that's a huge economic impact to the whole country, involving it in some huge economic transfer.… It's the biggest thing that has happened to expand government control on everything we do." Carlson also emphasized that "just providing insurance doesn't mean you're providing access or quality of care."
That's one of the bill's unanswered questions.
"It doesn't change how we have to figure out improving access and getting people more involved in their health care," said Bill Downey, president and CEO of Riverside Health System, admitting to surprise at the Supreme Court's "unique" interpretation regarding taxation. "They still don't have to have insurance. It's too early to know about charitable care and how many people will opt in or out."
With more people accessing care, an aging demographic, and constrained state budgets, Downey anticipates that the health system will have to provide the same level of care for less. "We're all going to be studying this for the next week or two," he said.
Michael A. Spine, senior vice president of business development at Bon Secours, lauded the decision. "We're happy because it continues a movement here in the United States that commits to expanding health care to all. This is one of the best ways to date to get there," he said.
Spine believes that better coordination of the country's "vast resources in health care" will enable the system "to take care of the vast majority of people without jeopardizing the quality of care." He cites the adoption of the "medical home" model as an example of one of multiple small experiments that have helped to control costs of health care.
One aspect of the bill poses a major economic concern for Jim Dahling, president and CEO ofChildren's HealthSystem, which includesChildren's Hospital of the King's Daughtersand multiple pedicatric physicians' practices. A little-known part of the bill involves a major cut in Disproportionate Share Funding, which helps bridge the gap between the cost of treating Medicaid patients and the amount hospitals receive as reimbursement. For most hospitals, expanded health insurance coverage will make up the difference; at CHKD, where Medicaid accounts for almost 60 percent of in-patient care, and without any anticipated coverage expansion, the potential annual loss could eventually total as much as $18.6 million due to a phased-in reduction starting in 2014. "It has potentially dire consequences for CHKD," Dahling said.Copyright © 2015, The Baltimore Sun