June 28--When Catherine Fitzgerald heard the news she was elated -- the Supreme Court upheld nearly all of President Barack Obama's Affordable Healthcare Act, including the controversial individual mandate requiring everyone to have health insurance by 2014.

Politicians from every part of the ideological spectrum sent emails hailing it as a victory or a tragedy. But for Fitzgerald, the law was personal.

"It means a lot," said Fitzgerald. "I'm on a fixed income and with the way prices are rising now, I just have enough money left to get groceries and medicine."

Fitzgerald has a series of health problems and must go for cancer screening every year. But for a long time, she had no health insurance at all and couldn't pay for a lot of services. While she got medical coverage, many of the services were still too expensive or were not covered at all.

Under the prevention and public health fund created under the ACA, Fitzgerald was able to get screenings and other preventative care measures doctors told her is necessary to her health. She said she pays 20 percent of most of her medical bills and insurance pays the rest. Fitzgerald hopes other people, especially of low income, will get the medical care they need under the ACA.

Fitzgerald's positive story is one of many in the Dan River Region -- an area of high unemployment and uninsured individuals.

Kay Crane, the CEO of Piedmont Access to Health Services, Inc. sees people like this everyday. Fifty percent of people served at PATHS do not have health insurance. Many private practice physicians are concerned about getting more Medicaid patients, but Crane said she hopes more Medicaid patients visit PATHS, because unlike private doctors, PATHS is designed to help the underinsured and receives enhanced reimbursement for those patients.

"We still feel like this is a victory because we see what happens when people don't have access to health care," said Crane. "...Until you are here and see how it impacts people lives it is easy to take an altruistic view."

Crane said communities like Southside will gain access to health care professionals and quality cost-effective services health centers like PATHS can provide under the law.

The Supreme Court found problems with the ACA's expansion of Medicaid, and Crane said they are waiting to see how the state handles this.

But not everyone believes this type of law is going to help people -- and it's creating a political firestorm.

"For those of us concerned with being uninsured the Supreme Court ruling is good news. Thirty-two million people are now a step closer to getting insurance," said Dr. Arthur "Tim" Garson Jr., a leading expert on national health policy and a professor of public health science and former dean of University of Virginia's school of medicine. Garson stressed he does not speak on behalf of the university.

He said for people who already have insurance, the ACA provides them with a safety net for health insurance if they lose their job and it also helps give coverage to people that don't have it.

The ACA was not constitutional under the commerce clause, but it can force people to pay a penalty for not having insurance -- like a tax. So now the political issue can easily become about taxes. As it stands now, people would have to pay a penalty tax if they can technically afford insurance but don't purchase it. People who cannot afford it will be offered subsidies and health exchanges to prevent this penalty.

"Whatever happens, we have to fix the system and if the detractors want to overturn this then it becomes an opportunity...It is certainly dependent on what happens in the election and who becomes president," said Garson.

Garson's biggest concern is that if the law is overturned in Congress, things go back to square one and health care reform becomes a political pariah.

"If there is a better way to do this then let's go find this," said Garson. "But we have a number of really good things that have already been implemented. My concern is there will be nothing done."

One of the "Obamacare" detractors is Rep. Robert Hurt, R-5th District, who said he was "very sad" when he heard the Supreme Court's ruling. He said while the court determines its legality, it is the responsibility of the people to decide its implementation.

"It is my hope that people will demand its repeal," said Hurt. "And I look forward to voting to repeal it."

The House of Representatives will vote again to repeal it on July 9, but the next election will have a major influence on the law.

Hurt, who is facing retired Gen. John Douglass in the congressional race, said that the Supreme Court ruling "ensures this issue is front and center" like it was in the last election.

Douglass said in a statement that he was pleased with the ruling he will continue "improving the current law to help companies and people gain access to affordable, quality care" if he gets elected.

Hurt is critical of the individual mandate and believes the law hurts business and health care overall. However, Hurt does acknowledge that there are problems in the current system and he supports several other bills in committee to help people afford coverage and have better access to health care.

Holland reports for the Danville Register & Bee.

What they are saying:

Tim Kaine, Democratic U.S. Senate candidate

"The Affordable Care Act is an important first step in curbing discriminatory insurance company practices and increasing access to health care, but more needs to be done to bring down costs. Our government, businesses, and citizens cannot continue to spend more than any other nation on health care while getting second-rate results."

George Allen, Republican U.S. Senate candidate

"I want to be the deciding vote to repeal this health care law. Virginians and Americans would be better served by reforms that deliver on the promise of reducing costs, increasing access to quality care, and put people -- not government -- in control of their health care."

Lt. Gov. Bill Bolling

"I am very disappointed by the Supreme Court's decision to uphold the constitutionality of Obamacare. It was my belief that the president and Congress overstepped their constitutional authority in requiring American citizens to purchase a product like health insurance, and I am disappointed that the Supreme Court reached a different conclusion. However, the court's decision does not change the fact that Obamacare is bad policy."

Gov. Bob McDonnell

"Today's Supreme Court ruling is extremely disappointing for Virginia and for America. The PPACA will create a costly and cumbersome system that will impair our country's ability to recover from these challenging economic times, infringes on our citizen's liberties, will harm small businesses, and will impose dramatic unfunded mandates on Virginia and all states. Simply put, this is a blow to freedom. America needs market-based solutions that give patients more choice, not less."

Former Rep. Tom Perriello

"The dream of universal, affordable health care has cleared its final hurdle, and every one of you owns a piece of that history. Today the American people won, and the Constitution once again survived the attacks of Confederationists ... Because of you, we have given power back to patients and doctors -- instead of health insurance companies -- to make your health care decisions."

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