Medical and public health officials in Tyler are surprised that the U.S. Supreme Court Thursday upheld the entire Affordable Care Act, a controversial health care law enacted by Congress in 2010.
“I actually thought that they would challenge some of the law,” said George Roberts, chief executive officer at Northeast Texas Public Health District. “I did not think it would come through all the way.”
Dr. Claire Tibiletti, president of the Smith County Medical Society and a pain management specialist at Azalea Orthopedics, was shocked by the outcome as well.
“I definitely thought the mandate would be (struck down),” she said. “I thought they’d tweak some of the smaller items, especially the one that affects Texas Spine and Joint Hospital where it’s said no physician-owned hospitals are permitted to expand. That’s an odd part of the law.”
In the law, physician-owned hospitals like Texas Spine and Joint, which Dr. Tibiletti is part-owner of, cannot expand. They sued the government in 2010 over that provision.
“We have to stay at 20 beds now,” Dr. Tibiletti said. “Unless something changes we can’t change that number. We’ve got a big decision to make … We’re going to have a conference call and discuss our options.”
The key part of the legislation, the individual mandate, requires all citizens to purchase health insurance when that portion is implemented in 2014.
The individual mandate was not upheld based on Congress’s power to regulate commerce between states to require people to buy health insurance. However, in a 5-4 vote, the Justices said that since individuals can refuse to buy insurance and face a penalty, it is a kind of tax that Congress can impose using its taxing power.
Effective April 2010, states receive federal matching funds to expand Medicaid. In that law, it required states to comply with the new eligibility requirements of Medicaid or risk losing funding. The Court said the government cannot withhold funding to states that do not choose to expand its Medicaid program to low-income citizens.
The Texas Medical Association, a group representing nearly 46,000 doctors, in a statement Thursday said there needs to be a way of caring for the uninsured population. The Smith County Medical Society, a chapter of TMA, aligns with the group’s message.
They have contended since the debate over health care reform began that there were parts of the legislation they approved of, while others need to be fixed.
“We need a local/state/federal partnership to design a fair and sustainable system,” the statement read. “Top-down mandates are not the answer.”
The group recommends that Congress and the Texas Legislature fix the Medicare physician payment formula, allow Medicare patients to contract directly with their physicians for any covered service and lift restrictions on physician hospital ownership, among other things.
“I do think there are good things in the law,” Dr. Tibeletti said. “I just think the way the whole law was presented and voted on in such a rushed manner didn’t allow — even the people voting on the law — any of us to look at it and offer suggestions or improve it.”
Dr. Gary Gross, an oncologist at Blood and Cancer Center of East Texas and president-elect of the Smith County Medical Society has been vocal about the need for more people to have access to health care.
“I think expanding the coverage is going to, hopefully, allow us to treat more patients,” he said. “The real reason that I think it’s important that the mandate held is you cannot provide more services for more people without increasing the size of the financial (pool). The risk pool has to include healthy people. The insurance companies need to have money from healthy people to allow them to afford to pay for health care for unhealthy people …
“The smaller that pool, the higher the premiums have to be for the people actually paying to cover the cost of delivering care to sick people.”
The health care law was spurred by a need to tackle health care spending, which reached $2.6 trillion in 2010, or 17 percent of the gross domestic product, according to the 2012 report compiled by the Centers for Medicare and Medicaid Services’ Office of the Actuary.
Texas leads the nation with uninsured citizens, according to 2010 U.S. Census data. Twenty-five percent of Texans are uninsured, which includes 17 percent of children and 33 percent of adults ages 19 to 64.