By Audrey Dutton and Rocky Barker — Statesman staff
The Supreme Court’s ruling Thursday to uphold the 2010 health care reform law got mixed reactions in Idaho. The court nixed the part of the law that gave the federal government the authority to withhold Medicaid funding from states that don’t comply with the law.
Some members of Idaho’s medical community rejoiced. Others, including Republican lawmakers, prepared to fight the law.
“While I accept the Supreme Court’s decision, I am disappointed that the government now has the ability to tax American citizens if they don’t purchase a private product and I remain concerned with the precedent that sets for the future,” said Rep. Mike Simpson in a statement.
Simpson added that the Supreme Court said the law was constitutional, not that it would bring down health care costs. “Congress should re-double its effort to repeal Obamacare and begin the process of enacting market-based reforms that will truly lower costs and increase access,” he said.
“Those who voted for this, every Democrat in Congress, should join us in repealing this massive tax increase,” said Sen. Jim Risch in a statement.
While the law may become a political football in 2012 campaigns and Congress may try to repeal it, the Supreme Court’s ruling preserves programs that benefit Idahoans, said Ted Epperly, who runs the Family Medicine Residency of Idaho. The law’s provisions will help Idaho rise from the bottom of the nation for primary health care, he said.
Medicaid expansion upheld, but will Idaho participate?
The ruling also upheld a rule opening the Medicaid program to people with incomes up to 133 percent of the poverty line. An estimated more than 80,000 people in Idaho would qualify in 2014 for Medicaid under that rule. More than 200,000 Idahoans are already on Medicaid. Under the 2010 law, most Idaho households that wouldn’t qualify for Medicaid would be able to buy insurance in a marketplace and would qualify for tax credits to help them buy it.
The Medicaid expansion will be completely or almost completely federally funded for the first six years, then 90-percent federally funded thereafter. But the Supreme Court left it up to states whether they would comply with that expansion.
“This holding will greatly limit what the law intended to do, which was to provide free health care to an additional 20 to 30 million people,” Risch said. “With today’s ruling, states will be relieved of this burden and the law’s primary objective will fail.”
About one-half of the patients who are seen by the Family Medicine Residency of Idaho are on Medicaid, Epperly said.
“We would probably have another 15 percent of people … covered then by Medicaid as opposed to being totally uninsured,” he said. “Many [Idahoans] now don’t come into the system at all. They live sicker and they die younger” because they put off treatment until problems are severe and more expensive, he said.
It’s decision time for an Idaho health insurance exchange
Blue Cross of Idaho, the state’s largest insurance company said it was “good news” that the court upheld an individual mandate if it was going to also uphold the requirement that insurers take everyone, not just healthy people.
“We really think it’s time [now] for Idaho to build a state exchange,” said Karen Early, spokeswoman for the insurer. If Idaho doesn’t get an exchange up and running for people to use to buy insurance by January 2014, the state will default to a federal system. Early said Idaho should run its own exchange because of the variations in insurance across the country.
“Insurance is built a little differently in the West than it is in the East,” she said. “The packages are much richer in the East, and therefore more expensive. … Idahoans [should be] in charge of their own, managing the data and managing how the exchange works.”
Wasden says court upheld Idaho arguments even as it sustained health law
The U.S. Supreme Court decision upholding the Affordable Care Act also sustained Idaho’s arguments against it, said Idaho Attorney General Lawrence Wasden.
Idaho and other states had argued that the law’s mandate to buy health insurance was an illegal use of the Commerce Clause of the U.S. Constitution.
“The court directly sustained our argument on that point,” Wasden said.
The court also agreed with the states that the law could not be supported as a “necessary and proper” act of Congress to carry out its powers, Wasden said.
But in the end it upheld the law based on the federal government’s taxing powers. President Barack Obama and Congress had said the penalties for not buying health insurance in the law were not taxes.
“The first incidence of the federal government claiming it was a tax was in district court,” Wasden said.
So what’s next? Wasden said he’s analyzing the decision to see what choices the state has. One is clear.
“One of the things the state can do is refuse to adapt the Medicaid expansion,” he said.
But as he has consistently said in the past the Idaho Leislature and the governor cannot nullify the law that is now recognized as constitutional.
“Congress can change it or repeal it,” Wasden said.
Hospitals say they’re not changing course
Both of Idaho’s largest health systems said they already were heading down a road that is now deemed constitutional.
“The Saint Alphonsus Health System will continue transforming healthcare from within, providing high value care that is patient-centered, coordinated and integrated. Even if the Supreme Court had decided differently, the reality is that healthcare is changing with or without this mandate,” said Sally Jeffcoat, the health system’s top official, in a prepared statement. “We are pleased with the Supreme Court’s decision. While we do not think the Affordable Care Act is perfect, we believe it goes a long way toward creating a healthcare system that is available for everyone.”
The president and chief executive officer of the St. Luke’s Health System said the Idaho Legislature must now scramble to build an Idaho health insurance exchange.
“When I’ve previously talked to [state] legislators, their view about the health insurance exchange was, ‘Let’s wait, because we’re pretty sure the Supreme Court is going to throw [the law] out [or] it will change with elections,” said David Pate, president and chief executive officer of St. Luke’s. But after the 2012 elections are over, “we’re running out of time,” Pate said. “Gov. Otter will have to call a special session, get the Legislature back to task on enabling legislation.”
Pate also said the Medicaid expansion a double-edged sword. A 150 percent enrollment spike in 2014 would give more Idahoans coverage for health care, but it wouldn’t create new doctors to see them, he said.
“That will put a lot of strain on the system,” Pate said. “We know what happens when people don’t have access [to health care providers], and they go to emergency rooms.”
Community health centers expect a wave of newly insured patients in 2014
Many of Idaho’s lowest income residents rely on community health centers, which take all patients regardless of whether they can pay.
The 13 centers in Idaho see more than 135,000 patients and take a half-million visits a year, said Jesus Blanco, policy director for the Idaho Primary Care Association. About 30,000 to 35,000 of those patients will likely qualify for Medicaid under a statewide expansion. Another 13,000 would be eligible for the tax credits to help them buy insurance on an exchange.
“Most of those folks are between 19 and 64,” lacking Medicaid and Medicare eligibility, he said.
Dan Hawkins, the policy director for the National Association of Community Health Centers, said Idaho lawmakers shouldn’t resist the Medicaid expansion for financial reasons.
He said the question for Idaho is: “Look, we’re paying these tax dollars; are we just going to let those go to other states? Or do we not want to see some of those dollars come back to Idaho and help Idahoans … so they are not reduced to resorting to hospital emergency rooms at later stages of illness, when it’s more costly and less effective to provide that care?”
Meridian doctor: “It’s just goofy what they decided to go after.”
Louis Schlickman, a primary care doctor in Meridian, was dispirited by the Supreme Court decision — not because of the constitutional reasoning, but because he never liked the law in the first place. Schlickman has pushed for universal health care.
“The reform bill was a big handout to the insurance industry,” he said.
He said the health insurance exchange proposal to the Idaho Legislature in the most recent session also was too friendly with insurers and other major players in the state’s health care industry.
Idaho patients have been “shoved to the background,” he said.
The law’s leveraging of Medicaid funds to make states cooperate with an expansion was a “goofy” thing to target, he said of the ruling. “We’re still stuck with an overpriced product that still leaves 25 million [Americans] uninsured,” he said.
Idaho House minority leader: “When pencil goes to paper,” lawmakers will acquiesce to Medicaid expansion
John Rusche, the House minority leader and a physician, said he’s “not ecstatic” with the Supreme Court’s ruling. Why? “I would have done health reform a little differently, but then, I didn’t have to get it passed through Congress.”
Rusche said Idaho has “a heck of a lot of work” to do before 2014. Two things should be done “right away,” he said — building a health insurance exchange and getting the state ready for a Medicaid expansion. But he expects legislators who championed nullifying the law in Idaho to fight it again.
About 294,000 people — about one in five — Idahoans were going without health insurance in 2010. Some of them had medical problems that ended up being paid for through state and county catastrophic funds. That cost about $78 million last year, Rusche said. The estimated cost to Idaho of a full Medicaid expansion is about $100 million to about $130 million over a six-year period.
