The CEOs of Fort Wayne's hospital systems agree that the Affordable Care Act, mostly upheld by the U.S. Supreme Court, will bring more patients to health care providers. They say that insuring more Americans should improve preventative care and may help control health costs.
Meanwhile, the Republican who represents Fort Wayne in Congress and the candidates running for governor already appear to be making the law, now more widely called Obamacare, important elements of their election campaigns.
More patients with more options
“The impact on us will be that more people will have access to care at the appropriate level,” said Mike Packnett, president and CEO of Parkview Health. If more people have health insurance, they will be less likely to wait until they must get urgent care at an emergency room. Hospitals are obligated to provide such care, regardless of a patient's ability to pay.
Joe Dorko, the CEO of Lutheran Health Network, said that the decision is good for patients, for society as a whole and for the hospitals in the Lutheran network. Insured patients will be more likely to get care, and the hospital is more likely to be paid for care it now cannot collect on. The benefit for society is that getting more people into a health care routine, instead of waiting for them to show up in emergency rooms, is that “maybe it will reduce the overall (financial) burden on society,” he said.
Thursday morning, the Supreme Court released its ruling in the challenge to Obamacare.
The 5-4 decision means the huge overhaul of American health care can proceed and accelerate over the next several years. Besides extending insurance coverage to perhaps 30 million more people, it will raise taxes on some businesses, institute a small increase in payroll taxes, offer more than half the households in America subsidies to help pay for insurance and compel millions of people who don't have insurance to buy it or pay a penalty. The Obama administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.
Questions on Medicaid expansion
An important part of the law the Supreme Court struck down was a mechanism the federal government would have used to compel states to extend Medicaid coverage to more people. The federal government can't pull existing Medicaid funding from states as punishment for not expanding its coverage.
That issue is almost certain to launch a fight in Indiana, one that's bound to play into the governor's race between Republican U.S. Rep. Mike Pence and former Speaker of the Indiana House John Gregg.
About two hours after the decision was announced, Pence blasted it in a press release.
"If ObamaCare is not repealed in full, Hoosiers will face higher health care costs and increased taxes. It is estimated that the ObamaCare tax on medical devices will cost Indiana more than 2,000 jobs in the medical device sector. While the changes in the punitive measures included in ObamaCare appear to give Indiana more options, that is small compensation for higher taxes and a government mandate that reduces the freedom of every Hoosier,” he said.
Gregg's endorsement of the ruling was cautious.
“Insurance companies cannot cut your insurance because you get sick. They cannot deny your coverage because you have a pre-existing condition. Young adults can stay on their parents' policy while they look for a job. Finally, senior citizens will continue to get a break on their prescription drug costs,” he said in a press release.
“We are currently examining the ruling to determine its effect on Indiana. … Congressman Pence has been part of the problem in Washington, siding with big insurance companies over Indiana families. He has voted against guaranteeing Hoosiers access to health insurance, voted against health insurance for sick children, voted against prescription drug coverage for seniors and voted to let insurance companies take away coverage if Hoosiers get sick. Indiana families deserve better," Gregg said.
Dorko and Packnett agreed that the growth of the population of Medicaid patients is so uncertain that they can't estimate its impact yet. People eligible for Medicaid will face the same mandate to obtain health insurance, but no one knows yet what kind of plan the state will develop.
Boon for health care or illusory solution?
The prospect of insuring millions more Americans is likely to bring more business to hospitals and other health care providers. Packnett said Parkview sees its greatest need as recruiting more primary-care physicians. Dorko said Lutheran's staffing needs are likely to extend beyond physicians to include nurses, physician's assistants and nurse practitioners, even housekeepers and cooks. And baby boomers among Lutheran employees are beginning to retire.
However, Dorko noted, “the market is pushing us faster than legislation,” that is, competition pushes health care providers to find efficiencies wherever they can.
U.S. Rep. Marlin Stutzman, who represents northeast Indiana, said the worst thing about the ruling is that it has “opened the door for any mandate to be a tax.”
He said that he would continue to fight to repeal ObamaCare, but the reality is that “this is going to come down to the election this year.” He said Republican Mitt Romney needs to win the presidency and Republicans must to gain control of the Senate and hold the House to have a shot at reversing ObamaCare legislatively.
Stutzman said that increasing the number of insured Americans fails to get at the “root of the problem. If we don't deal with the cost of health care, insurance is still going to be expensive.”
He suggested broader use of health-savings accounts and putting more responsibility on patients to spend health care dollars wisely will do more to control costs.
Packnett and Dorko both were optimistic that expanding insurance coverage can help control costs.
“I'm going to rely on the concept that it's better for a patient to see us with high blood pressure so it can be treated instead of waiting until (the patient) has a stroke,” Dorko said.
Packnett asked, “What can we do to change the way we look at health? … There's not enough done in the areas of prevention and wellness.”