A practicing internal medicine physician in Thomson, Dr. Jacqueline W. Fincher could hardly sleep Wednesday night but was pleasantly surprised when the law was upheld.
“It honestly didn’t go the way I thought it would,” she said between seeing patientsThursday. “It is surprising but honestly very exciting.”
Medical College of Georgia Hospital and Clinics had taken the reforms into account in its approach of forming more partnerships with physicians and community hospitals in trying to strengthen primary care at those levels and concentrating on more complex care within the health system, said David Hefner, the executive vice president for clinical affairs at Georgia Health Sciences University.
University Hospital has planned for the reforms by cutting costs because, even with greater coverage, the hospital stands to lose millions in the future from deep cuts in Medicare payments, CEO Jim Davis said.
With the ruling, “the unknown is eliminated,” he said.
At Trinity Hospital of Augusta, new CEO Jason Studley sees more uncompensated care being covered in the future. Doctors Hospital CEO Doug Welch pledged to work “with all of our stakeholders – elected officials, community leaders, clinicians and employees, to ensure the provision of this care continues smoothly.”
The Supreme Court held that Congress did not have the ability to “compel” people to buy health insurance through the Commerce Clause, Chief Justice John Roberts wrote in the majority opinion.
“The Framers (of the Constitution) knew the difference between doing something and doing nothing,” he wrote. “They gave Congress the power to regulate commerce, not to compel it.”
Using the government’s secondary argument, however, the court found that Congress could, through its power to “lay and collect taxes,” impose a tax on those who did not have health insurance, upholding the individual mandate. That means for Augusta providers that more patients will likely have health insurance beginning in 2014.
“That’s going to be huge,” Fincher said. “Every single day of the week, I see patients that are uninsured. It is a financial burden on the patient, and it is financial burden on me as a physician.”
If the patient turns out to have something serious, such as cancer, that could cost at least $50,000 to treat, Fincher said. It is no wonder medical costs are the leading cause of bankruptcy, she said.
For MCG health system, which provides about $100 million a year in uncompensated care, it could mean more compensation but also more activity from those who suddenly have access to primary and preventive care that they didn’t before, Hefner said.
“I think we are going to discover the pent-up demand is huge,” he said. That likely means higher short-term costs but potentially lower long-term costs.
“(The decision is) good news for people who will be able to visit doctors, utilize hospital services and obtain preventive health care,” Studley said. “We look forward to providing essential health services for more members of our community as coverage expands.”
Fincher said she has already seen the benefit of certain provisions of the law that have been implemented, such as requiring Medicare to pay primary care physicians like her 10 percent more for office visits and for preventive care, which should reorder the incentives in the health care system toward lower cost and better health. It already helps seniors pay for generic medications. There are about 3 million young people over age 21 who have been able to stay on their parents’ insurance until they are 26, Hefner said.
There are also beneficial insurance reforms ahead, such as eliminating the ability of insurance companies to deny coverage based on pre-existing conditions, Davis said. In an analysis done by Objective Health and presented Thursday to the hospital’s board, the Medicare cuts of $155 billion that the American Hospital Association agreed to as part of the reform wipe out any gain from more people being insured, Davis said. In University’s case, by 2019 more than $20 million more in care would be covered, but government payments would decline by more than $47 million, he said.
“From a hospital perspective, the bad part is those cuts that we’ve agreed to far exceed the reimbursement we’re going to get through expanded coverage,” Davis said. University has been planning to meet that by cutting expenses an average of 4 percent a year, he said.
The court also struck down the power of the Secretary of Health and Human Services to penalize states that do not participate in an expansion of Medicaid under the law. That would have covered 16 million people nationwide and 650,000 in Georgia, said Fincher, who is the managing partner of McDuffie Medical Associates in Thomson and governor of the Georgia chapter of the American College of Physicians. That puts the burden back on Congress to find a solution for those patients, she said.
“How are we going to provide insurance to the poorest and most vulnerable people?” she said.