June 29--WASHINGTON -- The Supreme Court settled the legal argument over health care Thursday. Now people in the United States will find out if President Barack Obama's overhaul can work as advertised to provide coverage to millions of uninsured while also keeping costs in check.
If it works, the U.S. will move closer to other economically advanced countries that for years have guaranteed health insurance to their citizens. If the plan falters, expect endless political wrangling over the nation's problems with high medical costs, widespread waste and millions of uninsured people.
But whether the plan works or not, local providers must now prepare for droves of previously uninsured patients taking advantage of newly secured health care.
Kathy Young, CEO of St. Joseph Hospital in Kokomo, said as every American becomes insured, the demand on primary care providers will skyrocket and "swamp" the current staff at St. Joseph.
Anticipating the steep uptick in demand, Young said the hospital has been routinely building up staff since Congress originally passed the law in 2010.
She said the facility also plans to work with Marian University of Indianapolis, which started a new medical school to help increase the supply of primary physicians.
However, the law creates no new money for hospitals to boost that supply. Young said St. Joseph is "reducing costs where it makes sense" and focusing on higher quality care.
Bryan Mills, CEO of the Community Health Network, which will finalize Sunday a partnership with Howard Regional Health System in Kokomo, said the law won't change what the hospital does, but how it pays for what it does.
"We still have to provide quality care to patients, but it will change where we look for funding to continue to provide those services," he said.
While health insurers, big hospitals and major employers have spent the last two years carrying out early provisions of the law and planning for many that are yet to come, the focus now quickly shifts from Washington to the states.
Although they are expected to play a crucial role in carrying out the law, only 14 states, plus the District of Columbia, have adopted a plan for doing so.
Hoping the Affordable Care Act will be overturned, Republican governors and legislatures have resisted setting up new insurance markets that are a linchpin of the legislation, and that could turn into a problem for the whole country.
The National Association of Insurance Commissioners expects only about half the states to be ready to set up new health insurance markets, set to open for business in 2014. If states aren't ready, the law calls for Washington to step in and run things.
State plans for the markets, called exchanges, are due to the federal government by this fall. In states that fail to go ahead, Washington will run the exchange, which is supposed to provide one-stop shopping for health insurance, steering middle-class households to private plans and low-income people to Medicaid.
Gov. Mitch Daniels said Indiana needs more information from the federal government before a decision can be made to either operate a health insurance exchange, leave its operation to the federal government or form a federal-state partnership.
According to the state, more than 550,000 Hoosiers currently are uninsured. Under the new law, individuals not covered by employer plans will be able to purchase health insurance from an exchange.
Daniels said the state also must decided whether to proceed with the health law's call for the expansion of Medicaid, which he estimates could cost Indiana$2 billion over 10 years.
The state also is awaiting word from the feds as to whether Daniels' program to insure more Hoosiers, the Healthy Indiana Plan, will survive. Any decision to expand Medicaid in 2014 "is entirely the province of the next General Assembly and governor," Daniels said.
Even with Thursday's court ruling, Obama's law is by no means the last word on health care.
Experts expect costs to keep rising, meaning that lawmakers will have to revisit the thorny issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the federal programs that cover seniors, the disabled and low-income people.
Even some supporters of the law acknowledge that it's only a first installment: get most people covered, and then deal with the problem of costs.
Kokomo Tribune reporters Ken de le Bastide and Scott Smith, and The Associated Press, contributed to this report.
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