UPDATE: Joe Thompson, AHA, Other Health Care Professionals React to Ruling

Health-care officials in Arkansas reacted Thursday to the U.S. Supreme Court's decision to uphold key portions of President Obama's health-care law including the individual coverage mandate.

The court by a 5-4 count upheld the individual insurance requirement that represented the heart of the debate but struck a provision expanding Medicaid services.

Paul Cunningham, senior vice president of the Arkansas Hospital Association, told ArkansasBusiness.com he thought the court would strike the individual coverage mandate and expressed disappointment that the court struck down the requirement that states expand their Medicaid programs or lose funding.

"It raises concerns about the potential for coverage of many low-income adults in those states that might opt out of expanding," he said.

Arkansas Surgeon General Joe Thompson, traveling home from a speaking engagement in North Carolina, told ArkansasBusiness.com that he was glad to have moved past "one more milestone toward whole system transformation," and that he believed Medicaid expansion still was "in play."

"This gives us some clarity," he said.

Thompson noted that the state was well on its way to implementing most of the law's provisions, and the ruling simply affirms what progress has already been made.

Gene Shelby, an ER doctor in Hot Springs and president of the Arkansas Medical Society, said in a statement that the organization agrees with the law's efforts to expand coverage for the uninsured. But the group maintains several points of contention with the law including:

  • New reporting requirements for physicians and other health-care providers
  • The limit on physician ownership of hospitals
  • Medicare restrictions that hinder the ability to recruit doctors and health-care providers to rural states like Arkansas
  • Concerns over the rising cost of defensive medicine
  • Medicare sustainability and its physician payment system
  • Patients' access to the doctors of their choice.

Dan Rahn, chancellor for the University of Arkansas for Medical Sciences, called the ruling an important step in ensuring access to health care for all Americans.

"We now have a frame work to achieve that goal," he said. "But we are still faced with the fundamental problem of uncontrolled costs in health care."

UAMS is an important part in the state’s safety net, he said, and in ensuring that all Arkansans have access to health care, "the challenge is to not have that contribute to cost escalation."

 

Tim Johnsen, president of Mercy Hot Springs (formerly St. Joseph's Mercy Health System), said the ruling serves as validation. Capella Healthcare is in the process of buying Mercy's Hot Springs hospital. It already owns National Park Medical Center in the city.

 

"We've been preparing for and pursuing necessary reforms for many years," he said. "We look forward to working with Capella, as well as state and federal government leaders, to continue building and implementing a new system of care in Hot Springs that preserves health care for the most vulnerable members of our society."

Max Greenwood, spokesperson for Arkansas Blue Cross and Blue Shield, said the state's largest private insurer was still studying the full ruling and its impact. She said Blue Cross already had implemented many of the law's applicable provisions.

John Robbins Jr. of Little Rock health-care software solutions provider Data Path said that whichever way the court ruled, the fight over health care and how to deliver it was bound to drag on. He expects a host of repeal efforts to fill the next few weeks.

Whatever happens, Robbins said his company prefers a more consumer-based delivery model for health care than what is currently available.

One of his biggest concerns is the so-called "Cadillac tax" provision of the law that remains intact. He said it will raise the premium thresholds for health-care plans eligible for taxation. It is scheduled to take effect in 2018, and Robbins believes that facet of the law will affect almost everyone.

Cunningham said AHA was "still trying to grapple" with the decision and its overall impact.

"Obviously, if you don't expand Medicaid then it limits accessibility insurance for a lot of low-income adults who still won't be able to afford it even going through the exchange," he said. "That means there still will be a significant number of uninsured people showing up in hospital emergency rooms, so in that regard it's a bit of a disappointment."

He said the law was never going to cover everybody anyway.

"But by striking the Medicaid expansion part of the law, I think you leave more people uninsured than would have happened otherwise," he said.

Cunningham said the Arkansas Hospital Association is still trying to digest the implications of the ruling. Other than that Medicaid portion, hospitals were moving toward complying with the law, he said.

Even if the mandate or the whole law had been ruled unconstitutional, "so many of our people are so far down that road that they would have continued anyway, but now they can do it as part of the law," he said.

Lt. Gov. Mark Darr, serving as acting governor while Gov. Mike Beebe is in France on an economic development junket, supported the provision of the ruling that strikes down the Medicaid expansion mandate.

"This ruling tells us the federal government cannot punish states if they choose not to participate in this Medicaid expansion program," he said in a statement released Thursday afternoon. "This decision underscores the fact that when Arkansas' political establishment said we had to grow government, they were wrong. What conservative legislators have been saying was right: we unnecessarily wasted millions of dollars starting health care exchanges in Arkansas when we didn't have to."

(Jennifer Ellis contributred to this report.)