U.S. Rep. Doug Lamborn declared it was a “sad day for freedom and liberty in America,” while President Barack Obama said the decision “reaffirmed a fundamental principle that here in America … no illness or accident should lead to any family’s financial ruin.”
Colorado Attorney General John Suthers, who joined the lawsuit that the Supreme Court heard in March, called it a “blow to our constitutional system of federalism.”
But hospitals and patient advocates are cheering, considering the ruling a victory for patients and for reducing hospital costs.
They’re ready to focus on implementing the remainder of the law.
“It’s time to move forward,” said Steven Summer, president and CEO of the Colorado Hospital Association. “We’re very excited about the decision, not from a partisan standpoint, but from the point of view that this puts stability into the health industry.”
Because of the Supreme Court decision, the state can move ahead with its health-care insurance exchange, passed last year. The exchange must be operating by January 2014. So far, Colorado is one of the states ahead of the game.
But there’s still work to be done, Summer said.
“We’ve started some things, when we passed the provider act in 2009, that expanded Medicaid to the levels the federal government wanted,” he said. “And we have a statewide system of electronic health records that we’re working on. We’re building the framework, and we’re just glad we can move forward from here.”
Summer said hospitals favor the Affordable Care Act because when people are insured, hospitals incur less charity care and bad debt. They can pass on those savings to insurance companies.
“We have hospitals laboring under intensive debt and charity care,” he said. “We’ve proven that when more people are covered, hospitals save money. They pass that savings onto insurance companies. If insurance companies don’t pass that on — well, that’d be a question an employer should ask them every day.”
The question isn’t whether the Affordable Care Act will save money, he said. The question is whether there’s enough transparency built into the law to hold insurance companies accountable.
“I guess the medical ratio that shows they have to spend 85 percent of premium dollars on health care, that’s one way of making sure they’re transparent,” he said. “I can tell you that we’ve proven in Colorado that if more people are covered, costs go down.”
Colorado passed the hospital provider fee a few years ago, with hospitals paying into a fund that expanded Medicaid. By increasing the number of people receiving Medicaid, Colorado’s hospitals were able to charge less.
“We can prove that, definitively,” he said.
The Supreme Court, while upholding the individual mandate as a tax, did say that states did not have to expand Medicaid or face losing federal dollars. In Colorado, that isn’t a problem.
“We’ve already expanded Medicaid to the federal levels,” said DeDe DePercin, executive director of the Colorado Consumer Health Initiative. “So we can count this as a huge victory for the patient.”
DePercin’s organization is helping craft the state’s insurance exchange, and also considers the Supreme Court decision as a positive step.
“Businesses might not realize that this is a benefit to them too,” she said. “Right now, they can get 35 percent of the premiums they pay for employees back as a tax credit. In 2014, that increases to 50 percent.”
Businesses and families should now have the peace of mind that they can afford health care, DePercin said.
“It’s a big deal,” she said. “We were already moving forward with some of the provisions, so it helps that Colorado is on track.”
The Colorado Medical Society said the decision defined the boundaries of state and federal participation in health-care reform.
“The ruling also means that the private and public sectors can continue the long-overdue process of providing access to care for the growing number of patients who have little or no coverage,” said Brent Keeler of the society. “Now we must intensify our local efforts to repurpose health delivery systems.”
But not everyone sees the Supreme Court decision in the same positive light. Politics aside, the decision and the law don’t do much to curb the escalating costs of health insurance, said Steve Berkshire, director of the doctoral program in health care administration at Central Michigan University.
And the decision does nothing to fix problems with Medicare. Doctors now face a 28 percent cut to reimbursement levels, something Congress puts off year after year.
“If those payments are too low, and continue to be low once the exchanges are in place, then patients could have trouble finding doctors who take the insurance plans,” he said. “We’re already seeing that with Medicare and Medicaid.”
Berkshire said the law didn’t really reform the insurance industry — and there was no way to make sure cutting costs at the hospital level would translate into lower insurance premiums.
“Insurance companies are barred from ending coverage because someone gets sick,” he said. “But they can still charge whatever they want. The law does little to address costs of premiums, particularly for small businesses.”
Since 2010, funding to Colorado entities under ACA
Number of people who have received added coverage for preventive services
Coloradans with Medicare who save money on prescriptions under the act
Number of Colorado children with pre-existing health conditions who can’t be denied coverage