Health care officals cheer ruling; local GOP leaders disappointed
By Susan Frick Carlman scarlman@stmedianetwork.com June 28, 2012 1:20PM
Maryjane A. Wurth, President & CEO of IHA, meeting with Chicago Sun-Times Editorial Board, Wednesday, April 11, 2012. | John H. White~Chicago Sun-Times.
Updated: July 30, 2012 6:18AM
Reactions were strong in the Naperville area among health care leaders and politicians following the U.S. Supreme Court’s decision Thursday to uphold the centerpiece of President Barack Obama’s Patient Protection and Affordable Care of 2009.
The decision means the ambitious overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also handed Obama a campaign-season victory by rejecting arguments that Congress went too far with the individual mandate: the legal requirement that most Americans must have health insurance or pay a penalty.
The health care reform act’s supporters embraced the long-awaited opinion from the high bench, while its opponents — describing the legislation as a tax hike of historic proportion — vowed to continue their effort to overturn it.
The Naperville-based Illinois Hospital Association, long supportive of the reform law, cheered the ruling.
“Because of this legislation, people in Illinois will no longer have a diminished quality of life, be at risk of dying merely because they lack health insurance, or be forced into bankruptcy because of a devastating diagnosis,” Maryjane Wurth, IHA president and CEO, said.
The IHA has been moving ahead in anticipation of the new policies and procedures the act will bring, taking such steps as initiating programs focused on quality improvement and boosting patient safety and infection control.
“The goal is to create new and efficient models of health care delivery to improve outcomes and lower costs,” Wurth said.
Although some pieces of the law already are in place, such as coverage for children up to age 26 and an assurance of insured medical care for children and others who have pre-existing conditions, Edward Hospital in Naperville is poised to put the remaining elements into place.
In a statement released Thursday afternoon, Edward Hospital CEO Pam Davis said the Naperville medical center is addressing the requirements of the law already, through partnerships with doctors and the DuPage Medical Group.
According to Edward vice president Brian Davis, that means sharing best practices, treatment protocols and certain administrative expenses, and measuring care quality jointly.
“Health care reform calls on hospitals to be more effective and efficient in how we deliver health care. There’s going to be more insured patients out there, but there’s going to be tremendous pressure on payment for services,” he said.
The managed-care partnership links the city’s largest employer with the region’s largest medical group.
“A few years ago, there were a lot of hurdles and regulations that would not have allowed us to partner with DuPage Medical Group like we are,” Brian Davis said. “But health care reform is allowing us to partner with our independent physicians and DuPage Medical Group.”
Standing firm
U.S. Rep. Judy Biggert, R-Hinsdale, whose district includes Naperville, reiterated her opposition to the act, repeating her prediction that small business owners will be particularly hard hit by the new requirement for universal insurance coverage.
“Under the administration’s law, too many families will lose the plans they have, and small businesses are afraid to hire new employees,” Biggert said in a statement issued shortly after the ruling came down. “We should go back to work on effective, bipartisan reforms that Democrat leaders ignored, like Association Health Plans for small businesses, allowing consumers to buy insurance across state lines, and medical malpractice reform.”
The lawmaker stopped short of condemning all of the provisions, saying “we can and should maintain coverage for pre-existing conditions and young adults under 26,” but made clear her continued opposition to the reform act.
“I’m disappointed that the Court did not put a stop to the government overreach,” she said in the news release. “But Washington still has a responsibility to fix policies that are raising costs, hurting job creation, siphoning millions from Medicare, and placing an added layer of bureaucracy between patients and their doctors.”
The court’s interpretation of the mandate provision drew substantial interest. The 5-4 vote ruled that the government has no authority to require citizens to purchase health insurance under the Constitution’s commerce clause, but it may rule within the context of taxation.
That took Robert Jones by surprise.
“It didn’t look like a tax,” said Jones, an associate law professor at Northern Illinois University who specializes in constitutional law. “It’s really a surprising ruling for a lot of different reasons.”
While determining enforcement of the mandate through the commerce clause would be unconstitutional, the court reasoned that it does fall under the federal government’s taxation powers. Jones said it was “kind of stupid” for Congress to frame the mandate originally as a penalty.
“It’s not a penalty anymore. It’s a tax,” he said. “The idea now is that if you don’t buy your own insurance, the government is going to make you pay a tax and they’ll use it to pay for your coverage.”
The court opinion predicts about four million Americans will be unwilling or unable to buy themselves insurance.
“Instead, they’ll just pay the IRS in their taxes and then they’ll be covered by the government program,” Jones said.
U.S. Rep. Randy Hultgren, R-Wheaton, called the decision “a shame.”
“Actions have consequences, we all know that. In this case the court has ruled that the government can tax you not only for choosing an action — moving to a certain neighborhood, earning a certain amount, or having a certain number of dependents — but for choosing inaction. This is unprecedented,” he said in a prepared statement. “Should we levy a special tax on individuals who don’t give to charity? Should we penalize families that don’t buy American built cars?”
Split bench
Chief Justice John Roberts, widely perceived to be unlikely to support the reform act, joined the court’s four traditionally liberal justices — Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor — in the outcome. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.
“The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding,” the dissenters said in a joint statement.
The vote tally was unexpected.
“We all thought Kennedy was going to hold the cards. He’s the swing vote. Here he didn’t. It was Roberts,” Jones said. “To have Roberts flip, and then the tax issue, is just really surprising.”
In a sense, the chief justice walked a tightrope with his stance. NIU political science professor Art Ward said all of those on the high court were keenly aware that the outcome of the challenge to the reform act would inform much of their legacy.
“In my experience, to say the court is insulated from the larger political environment is nonsense,” Ward said. “Whenever a blockbuster decision is going to come down now, they know it.”
Roberts in particular, he surmised, was keyed into the climate of public opinion.
“Does he want to be known as the chief justice who struck down a signature piece of legislation? I don’t think so,” he said. “I think it came down to ‘I don’t want to be the guy who’s thwarting the will of the American people.’”
Another faculty member at NIU projected that when the dust settles, the business community will have weathered the effects of the new requirement.
Public health professor Jim Ciesla, who specializes in health economics, said small business owners will face a learning curve because many of them have not provided a health insurance benefit for their employees before.
“In a shorter-term time frame, it creates a lot of uncertainty. It certainly is expensive,” Ciesla said, though he noted that many businesses can build the expense into their long-term planning. “I think the effect of it over the long haul, if I had to speculate, is that eventually it will level the playing field between large employers, who are more able to spread out the expense, and smaller businesses.”
Republican campaign strategists said presidential candidate Mitt Romney will use the court’s ruling to continue campaigning against “Obamacare” and attacking the president’s signature health care program as a tax increase.
“Obama might have his law, but the GOP has a cause,” said veteran campaign adviser Terry Holt. “This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history.”
The Associated Press contributed to this story.
