June 28--Reaction was swift and sharp following the U.S. Supreme Court's momentous decision upholding the Obama Administration's signature health care reform law.

"The health care debate highlighted the overall need for access to adequate health care, so this ruling is a monumental day for Pennsylvanians and all Americans," said state Sen. Shirley Kitchen, D-Philadelphia. "The Supreme Court's decision to uphold the president's health care law will have a dramatic impact, especially for those who can't afford or have been denied health coverage."

The ruling keeps in place a law with a game-changing goal of opening the health insurance marketplace to millions more Americans. Its impact reaches far beyond the uninsured, however, by providing benefits for people with chronic illnesses, the young and the elderly.

"Young adults can remain on their parents' health plans, insurance companies cannot deny us when we get sick and our grandparents will continue to get help with their prescription coverage," said Antoinette Kraus, project director for the Pennsylvania Health Access Network. "It is now time for Gov. Corbett and our elected leaders in Harrisburg to get to work implementing the Affordable Care Act in Pennsylvania."

Opponents saw the ruling as a deeper intrusion of the federal government into American lives.

The Affordable Care Act will be another burden on business, said Tony Iannelli, president of the Greater Lehigh Valley Chamber of Commerce.

"Business and commerce are pleading with government to get the hell out of the way and drive the economy forward," he said, "and these broad-based programs don't help."

At the same time, Iannelli acknowledged that to many people, including the elderly and the uninsured, the ruling was good news.

"Deeply disappointed #SCOTUS upheld #Obamacare," U.S. Sen. Pat Toomey, R-Pa. told his Twitter followers. "Ruling is a blow to personal liberties. Up to #Congress now to pass #FullRepeal."

U.S. Rep. Charlie Dent, R-15th District, also called for repeal: "With the Supreme Court's decision now behind us and serious fiscal challenges before us, I believe we are presented a new opportunity to identify the failures of our health care system, repeal the law and then carefully develop solutions catering to the diverse needs of the American people."

U.S. Sen. Bob Casey, D-Pa., pointed out popular elements of the law, and then said: "I will continue to work with other senators to make improvements to the legislation. Further, there is no doubt that we still confront significant challenges to reducing the cost of healthcare and the only way to address these in the long-run is for Democrats and Republicans to work together."

Tom Croyle, executive director of the Lehigh Valley Business Conference on Health Care, said the certainty provided by the ruling will help businesses plan for how they will provide coverage for their employees. The government needs to continue providing guidance to employers so that they can meet the law's requirements, he added.

"We look forward to working with providers and insurers to implement programs and initiatives such as patient-centered medical homes, patient safety and data transparency required to truly transform our nation's healthcare," he said.

A health insurance industry representative said insurers would work with the Corbett administration to implement the law tailored to Pennsylvanians' needs -- even if those businesses were not happy about it.

"The Supreme Court ruling means the slippery slope towards federal control of the health care and health insurance industry has just accelerated," said Scott Mardis, president of the Pennsylvania Association of Health Underwriters. "Throughout the implementation, the Patient Protection Affordable Care Act has undercut the private sector health insurance system by forcibly increasing benefits (costs to insurers) without allowing them to break even, writing the rules so that almost no one can be grandfathered, and establishing a maze of new government rules that even the government cannot explain."

In a part of the decision, the court said the law went too far in requiring states to expand Medicaid, a federal/state health insurance program for the poor. Washington cannot penalize states that refuse to do it under the law by withholding federal Medicaid funds, the court said.

The result is fewer people will have health insurance, and fewer tax dollars will be needed.

In Pennsylvania, 750,000 people would have been added to the Medicaid rolls at an extra cost to the state of $2 billion, said state House Health Committee Chairman Matt Baker, R-Tioga. But, he said, the provision would have triggered a "mass exodus" of states from Medicaid.

"It was a huge potential budget buster," Baker said.

The Kaiser Family Foundation estimates the expansion would provide health care to another 500,000 or so Pennsylvanians at a cost of $1 billion through 2019.

Corbett, who opposed the federal law prior to taking office, on Thursday did not say wants he wants to do with its Medicaid and other provisions, saying the administration needs more time for review.

As state attorney general in 2010, Corbett joined a now-unsuccessful lawsuit seeking to overturn the provision that requires most Americans to have health insurance or pay a penalty.

"My administration will do what we can to ensure the negative impact of the law affects the lives of Pennsylvanians as little as possible," the governor told reporters Thursday. "I think we can all agree there are Pennsylvanians who need our help. However expanding government programs, government spending is not the answer."

Hundreds of thousands of Pennsylvanians already have taken advantage of early provisions of the federal health care law, the main parts of which won't roll out until Jan. 1, 2014.

Under the benefits first provided by the health care law, 91,000 young adults in Pennsylvania without job-based coverage were allowed to go back on their parents' plans, according to the U.S. Dept. of Health and Human Services.

Other statewide beneficiaries: More than 5,000 people locked out of coverage because they had a pre-existing condition entered a state-run health program. About 250,000 senior citizens received increased payments to close the Medicare Part D "doughnut hole." More than 1.5 million received preventive services with no co-pay or deductible.

The federal government also spent tens of millions more on a wide array of programs, funding a state insurance exchange, community health centers and maternal and early-child health programs.

More than 62,000 people in the Lehigh Valley under age 65 are without insurance, according to the most recent estimates by the Robert Wood Johnson Foundation. Nationwide, 50 million people were uninsured as of 2010, the U.S. Census Bureau said.

Prior to the decision being announced, it was a colorful, carnival-like scene in front of the Supreme Court in Washington. Protesters include a minuteman in full costume and a crowd of Tea Party faithful with large yellow "Don't Tread on Me" flags. They sang, "Let's have a party, a Constitution party."

Competing was a conga line of Obama health care supporters dancing to Stevie Wonder's "Signed, Sealed, Delivered, I'm Yours." The makeshift posters include I ? Obamacare and one that said, "I ? Romneycare."

Belly dancers performed in support of single payer, "Medicare for All." With them were people in surgical masks that said "Silenced Majority" in marker.

Meanwhile, people came to witness the moment inside the court. Chau Lam, 28, a Penn graduate who studied public policy, felt it was appropriate to be at the Supreme Court for the opinion. She got in line at 3:30 a.m. and was 52nd in line. As of 8:30 a.m., the first 50 people had been allowed inside. People had slept overnight in line.

Lam said the law should be upheld. "I think the way that health is taken care of in this nation we end up paying one way or another," she said.

tim.darragh@mcall.com

610 778-2259

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