June 28--Gov. Scott Walker on Thursday reaffirmed his refusal to implement the federal health care law, despite the Supreme Court's ruling to mostly uphold it.

Advocates in the state praised the court's decision, a business group opposed it, and health care providers questioned some of its implications.

Walker said he hopes that after November a new president and Congress will end the law, saying it "would require the majority of people in Wisconsin to pay more money for less health care."

Walker's health services secretary and insurance commissioner also issued statements criticizing the court ruling.

The law "is now revealed as an enormous and regressive tax on Americans. It will increase taxes especially on the poor. It will increase the cost of insurance on working middle class families," said Dennis Smith, secretary of the Department of Health Services.

Ken Taylor, executive director of the Wisconsin Council on Children and Families, called the court ruling "great news for everyone in Wisconsin."

The decision ensures that children will have access to quality, affordable health care, Taylor said in a statement.

The law has helped children with asthma, diabetes and other medical conditions by not allowing insurance companies to deny them coverage, he said. The court's ruling means 29,000 Wisconsin children who could have potentially lost BadgerCare coverage won't, he said.

Wisconsin'sCommunity Health Centers, including Access Community Health Centers in Madison, are ready to serve more patients under the law, a group representing the centers said.

"With the funding available under the Affordable Care Act, our health centers will be able to serve more patients in underserved areas across Wisconsin and put more people to work in the process," said Stephanie Harrison, executive director of the Wisconsin Primary Health Care Association.

But the decision will hurt small businesses and strip Wisconsin residents of their ability to make personal health care decisions, Bill Smith, state director of the National Federation of Independent Business, said in a statement.

"Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable," Smith said.

Dr. Tim Bartholow, senior vice president of the Wisconsin Medical Society, said the law's expansion of insurance could cause more people to get primary care, preventing some costly hospital stays.

But he said the medical society is concerned about a predicted shortage of nearly 2,200 doctors in Wisconsin by 2030, especially in primary care.

"We remain absolutely concerned about the workforce," Bartholow said.

The law brings a $2.6 billion reduction in Medicare payments to Wisconsin hospitals through 2019, according to Eric Borgerding, a lobbyist with the Wisconsin Hospital Association. The money will pay for the law's Medicaid expansion and subsidies for people to buy insurance on health care exchanges.

But Wisconsin hospitals are "well positioned" to deal with the Medicare cuts because they are improving the quality and efficiency of care more than in other states, Borgerding said.

The court decision could boost Wisconsin's insurance coverage rate, already better than most states. The expansion might be scaled back because the court found problems with the law's expansion of Medicaid, the state-federal health plan for the poor. But that provision affects Wisconsin less than some other states because its Medicaid program already covers more people than required.

About 526,000 state residents, or 9.4 percent of the population, were uninsured in 2010, according to the U.S. Census Bureau. Only Massachusetts and Hawaii had lower rates. The national average was 16.3 percent.

About 1.2 million people in Wisconsin, or one in five residents, is on some form of Medicaid. Roughly 777,000 are on BadgerCare Plus, which mostly covers low-income families and children.

Two-thirds of Wisconsin's uninsured residents, or about 340,000 people, would become insured by 2016 under the full federal law, according to a report last year released by Walker's administration and commissioned by the administration of former Gov. Jim Doyle. Without the individual mandate that was upheld, that figure would have dropped to just 62,000 newly insured, the report said.

Some people who buy insurance on the individual market will face higher premiums, the report said, in some cases because the law requires better benefits. Others, especially older workers, will pay less.

It's unclear how much the state might have to pay to continue covering childless adults on the BadgerCare Plus Core Plan.

Meanwhile, the federal government in May approved state changes to BadgerCare Plus expected to cause 17,000 adults to lose state coverage and 30,000 others to pay more for it.

The changes include dropping some enrollees for a year if they don't pay their premiums, not granting coverage retroactively and refusing coverage if people can get employer insurance for less than 9.5 percent of their incomes.

Wisconsin has until July 23 to meet federal conditions for Family Care, the state's Medicaid program to keep the elderly and disabled out of nursing homes. The state lifted an enrollment cap in April but could be forced to make retroactive payments to some people affected by the cap.

While the federal health care law lets parents keep children on their health insurance policies until age 26, a similar law in Wisconsin covers adult dependents up to age 27.

Consumers and employers in Wisconsin stand to receive $10.4 million in rebates in August from health insurance companies under the federal law, state and federal officials announced last week. The insurers failed to spend at least 80 percent or 85 percent of premiums on medical expenses as required by the law.

Most of the money will go to employers. Nearly 20,000 individuals can expect rebates averaging $63 per family.

In Madison, a plan by Dean Health System and St. Mary's Hospital to take advantage of new Medicare payments encouraged by the federal law continues, a Dean spokeswoman said.

The providers applied in March to become an "accountable care organization" and receive Medicare payments based on quality measures, not just on the volume of care provided.

If Dean and St. Mary's reduced readmission rates for patients discharged from the hospital, for example, they would share in savings from Medicare.

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