By Lauren Ratcliffe
lratcliffe@scbiznews.com
Published June 28, 2012

In a narrow 5-4 decision, Chief Justice Roberts joined his more left-leaning colleagues to uphold the Affordable Care Act.

The opinion gave the OK to the controversial provision known as the “individual mandate,” but did so provided it is viewed as a tax. That provision requires most Americans to purchase minimally adequate health coverage by 2014 or face a penalty in the form of higher taxes.

Providers and educators react
Health care providers are looking at the court’s decision from a largely positive stance, but acknowledge there will be pressures on the industry to use funds and see patients more efficiently.

“It’s not a perfect solution and I know the political battles will continue but we are preferring to look at this from a glass half full perspective,” said David Dunlap, president and CEO of Roper St. Francis Healthcare in Charleston.

More coverage Read more local coverage on how the Supreme Court’s health care ruling will affect South Carolina.

Dunlap said the court’s decision was much awaited and said the requirement of insurance will ultimately help his business because more people will be receiving treatment with the payment assistance from insurance policies.

“One of the things we’ve been dealing with is the uninsured people who need care and do not have (insurance),” Dunlap said. “We often have to care for that population as a charity.”

Representatives from Bon Secours St. Francis Health System in Greenville said they were initially pleased with the decision by the court because of its expansion of coverage for the uninsured. They also said they are still learning more about the opinion.

Todd Miller, vice president of marketing and communications for Palmetto Health in Columbia said he, too, was pleased with the court’s decision because it took uncertainty out of the equation.

“Palmetto Health is pleased that the Supreme Court’s ruling has clarified key questions and issues about the constitutionality of the Patient Protection and Affordable Care Act,” he said in a statement.

“But even before this legislation was introduced, Palmetto Health recognized the need to improve health care in our community. Our work over the years has been driven not by the Affordable Care Act, but by our mission to improve the physical, emotional and spiritual health of all individuals and communities we serve,” he said.

Bill Moran, director of MUSC’s division of general internal medicine and geriatrics called the decision a “major step toward making sure all citizens have access to basic health care services.”

Moran expressed disappointment that the court did not make the expansion of Medicaid mandatory, but rather a choice of the states. The law makes federal funding available to states that choose to expand Medicaid eligibility. The court’s opinion restricted the federal government, saying that they are unable to withdraw or deny funding from states that do not expand the program.

“The carrot for the first couple years is in the bill,” Moran said of the federal government’s covering of costs associated with Medicaid expansion. “When those expansion costs revert to the states, it would cost the state budget another half billion dollars and that’s a real amount.”

Moran said that the health care system in the state is equipped to handle patients, but the challenge is going to be finding primary care doctors to fill what may become a growing need.

“We have adequate hospital beds and hospital services across the state, but we don’t have enough primary care,” he said. “A big part of expansion of access is going to be expansion of primary care.”

“By expanding primary care access (through insurance), we will reduce the stresses on emergency care,” Moran said. “If we can expand the primary care workforce fast enough, it will be a good thing.”

Political praise and finger pointing
State politicians reacted to the court’s opinion largely in opposition.

Gov. Nikki Haley called the decision a barrier to allowing states to care for their residents.

“This is a tax increase for the people of South Carolina. It’s a tax increase for the people of America. It is a job killer, and it’s the government getting in the way,” she said. “This decision concludes one thing and one thing only for me and that is that we have to have new leadership in Washington.”

Republican Sen. Lindsey Graham also called the law a tax increase on Americans.

“The problem for the American people is this is a massive tax increase at a time they can least afford it, and Obamacare will jeopardize the quality and accessibility of health care,” he said. “Now Congress has a chance to repeal and replace Obamacare, one of the largest tax increases on the American people, with common-sense health care reform we can afford.”

Representative Tim Scott said he was extremely disappointed with the court but insisted that the decision was a call to action for Republicans in their efforts to repeal the law.

“We will work tirelessly to lower health care costs, repeal the tax known as the individual mandate and put health care decisions back in the hands of mothers and fathers, sons and daughters, and their doctors,” he said. “I hope every American takes this opportunity to stand up and voice their opposition to this monstrosity, and I will be standing right there with them. This isn’t the end of our opposition; this is a new beginning.”