Thursday's Supreme Court ruling upholding the Patient Protection and Affordable Care Act has proponents praising the decision, opponents vowing to fight on against the law and just about everyone trying to decipher what it means for the long term.
Carroll County uninsured residents
On Tuesday, Sheila Restivo was sitting in an Access Carroll patient room awaiting a follow-up appointment to an incident last month. The nonprofit located in Westminster offers free care to the county's uninsured and low-income residents, and Restivo meets that criteria.
The 56-year-old woman was mowing her Greenmount home's front lawn May 8 when she stopped suddenly.
"I just could not breathe," she said. "It wasn't a shortness of breathe. I just couldn't get air in. I thought I was dying. It was the most terrified I've ever been in my life."
Restivo, who is self-employed, had to halt her health insurance in 2008 - the same year she was cleared of bladder cancer - after business slowed, and she simply could not afford to lose the $222 per month BlueCross BlueShield health insurance was costing her. So, she tried to wait out the heart attack-like feeling. The next day, she remembered Access Carroll could help her.
Carroll County has 8,321 people like Restivo who don't have insurance, according to the 2010 Census Bureau's American Community Survey. That's 5 percent of the population, compared with 11.3 percent of Maryland residents who are uninsured. Carroll County has the lowest percentage of uninsured residents in the state, according to census data.
While several county health officials said this number seems low - Carroll County Health Officer Larry Leitch, Access Carroll Executive Director Tammy Black and Partnership for a Healthier Carroll County Executive Director and CEO Patricia Supik estimate it to be about 15,000 to 20,000 - such residents will now have health insurance to lean on in times of need. And also as a preventive measure.
"Carroll County residents are well-insured, usually," Leitch said. "But like many Americans today, we don't take care of ourselves the way we should. If doing the things to take care of ourselves [is] free or very inexpensive, we may be a little bit better off in the long run."
In 2009, Obama and the U.S. Congress hammered out a law aimed at affordable, universal heath care for all Americans. At the time, the United States was the only developed nation to not have such coverage. It passed in both the Senate and the House of Representatives - as Democrats controlled both - amid heavy opposition from Republicans.
From March 26 to March 28, the Supreme Court heard six hours of emotional testimony on this legislation that touches every American and percolates through the business, political and economic spheres nationwide. In a 5-4 ruling Thursday, Chief Justice John Roberts surprised many as the right-leaning justice providing the crucial fifth vote needed to keep the law intact.
"The Framers created a federal government of limited powers, and assigned to this Court the duty of enforcing those limits," he wrote in his 59-page opinion. "The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people."
Americans will now be required to have insurance or pay a fine, cannot be turned down due to pre-existing conditions, will receive free preventive care services and more; the Affordable Care Act will be almost fully implemented Jan. 1, 2014.
Some, such as Maryland Gov. Martin O'Malley, a Democrat, praised the ruling, saying it aligns with such measures already occurring in this state.
"In upholding the Affordable Care Act, the U.S. Supreme Court chose to protect the lives of millions of Marylanders and millions of Americans. American businesses will be more competitive in the global economy with lower health-care costs and a healthier workforce," he said in a press release, adding, "Today's decision gives considerable momentum to our health-care reform efforts here in Maryland. What it does not - and indeed must not - do, is give us license to take our eye off the ball or slow our progress."
But staunch opponents said this fight isn't over. State Del. Justin Ready, R-District 5A, said the majority of Carroll County residents are pro-health-care reform but against the Affordable Care Act.
"I've heard loud and clear over the last couple of years when I was campaigning in 2010 and the last year and a half being on the job that people are concerned about the cost of health care, they're concerned about the government telling them what they have to purchase and what they have to do," he said
Carroll County Commissioner Haven Shoemaker, R-District 2, strongly opposed the court's decision, calling it the "ObamaCare fiasco."
"My gut reaction is that I'm dismayed, both as a lawyer and as an American, by the Supreme Court's decision on Obama's socialized medicine scheme," Shoemaker said. "With this, America got a big tax hike and suffered a loss of its liberty today."
Another one of those opponents is Restivo, who is uninsured. She said wants affordable health care, but not like this, not with this tight governmental hand.
Reform's a process
It's a long road to actual reform in the nation, and in Carroll County, too.
"It's nice to be able to insure them, but we still have to evolve our system into a coordinated, integrated system from the fragmented system that exists," said John Sernulka, president and CEO of Carroll Hospital Center.
About one-third of the county's physicians are "part of the hospital family," he said. Daily conversations he has indicate this fraction will move to about 50 percent or more in about five years, Sernulka said.
This is important because hospital doctors cannot restrict who they see based on the kind of insurance they carry; only independent doctors can. And since millions more Americans will be insured, health officials like Leitch worry there could be lengthy waiting lists to see a doctor.
"I think a lot of the primary care physicians in any community - family practice doctors, pediatricians, the family kind of doctors - I think they may have difficulty in handling the increased number of people with insurance," Leitch said. "I think the [Carroll County doctors] are going to have problems like most communities when this kicks."
It's going to be a learning process, said Black, of Access Carroll.
"Sharing resources, partnering, collaborating, coordinating care, talking and communicating better, electronic health record, oh my gosh, all these things are just pieces to the bigger puzzle. If one part isn't willing to participate, you're going to have this gap - this big hole - in the puzzle," she said. "It's really going to come down to people putting aside personal ambitions and looking at the community as a whole and figuring it out as a group collectively."
Times staff writer Christian Alexandersen contributed to this report.