MILLERSBURG -- When the Supreme Court upheld most of the Patient Protection and Affordable Care Act on Thursday, there was a political fallout. But what will it mean for health care providers?

What the ruling means for Pomerene Hospital is that it's going to be "business as usual," Chief Executive Officer Tony Snyder said.

"We're going to provide health care no matter who you are if you come in our doors, whether you can pay or not pay," Snyder said. "Our focus has been on appropriate care in an appropriate setting at the appropriate time for appropriate cost. We'll continue to do that."

"Now that the decision over the constitutionality of this legislation has been rendered, it still begs the bigger question," Wooster Community Hospital CEO Bill Sheron said in an email. "Although many people may be pleased with a number of the individual provisions of the Accountable Care Act, as a health care executive I remain concerned over how it will be funded. I do not believe this has been adequately discussed or addressed in this bill. The larger issues are overall national health spending within the context of our significant federal budget deficit. This is not meant as a political statement, but people may wish to visit the website usdebtclock.org to understand the magnitude and urgency of this situation."

Tom DeBord, president of Summa Wadsworth-Rittman Hospital and Summa Barberton Hospital, said the funding aspect is part of the debate and parts of the act remain controversial, but his health system is moving forward. While implementation of the law will be challenging, the national health care system is not sustainable the way it is now, he added.

"The reality is we have to drive costs out of the system, and when we look at the overall costs and what the government spends, it is unsustainable. It has to be reformed," DeBord said.

Dr. Tony Tizzano, medical director of the Cleveland Clinic Wooster, said the decision means that all of the industry is taking the next step in the journey of reforming health care.

"We know something needs to be done, and now it is at our doorstep," Tizzano said.

In order to drive down costs and improve the quality of the care provided, DeBord said he believes it will force providers to look at ways to be more efficient and to collaborate on best practices.

About 50 percent of health care costs are related to chronic diseases, Tizzano said. "This is caused by lifestyle choices. The focus needs to be on us to get healthier."

While traditionally the model has been when people become ill they seek out a physician to help solve the problem, going forward, it should be on preventing people from getting ill, Tizzano said.

"Overall, we have to look at ways that we've been doing things and we have to be ready to change quickly and some of the changes could be substantive," said Snyder, noting that at Pomerene they'll keep doing what they're doing "with renewed energy and focus on these."

Tizzano said for years the Cleveland Clinic has been working on ways to manage costs and improve outcomes. Some of the actions include the implementation of electronic medical records that can be viewed and accessed across the system and its model of institutes of health where physicians have access to the Cleveland Clinic's top specialists in a variety of fields.

One result of the individual mandate being declared constitutional will be a dramatic increase of the number of insured people in the community.

"Those who don't have (insurance) now will have it by 2015, assuming they don't take the penalty," said Snyder, noting that in Holmes County, most of these yet uninsured people would fall under Medicaid. This could be problematic, as many primary care physicians no longer accept Medicaid coverage.

"We don't have a surplus of primary care physicians (in the community) ... This is something we will have to look at -- what's the impact on that primary care: Will they have physicians or will they use the (Emergency Department) even though they do have health insurance?"

Mike Abrams, president and chief executive officer of the Ohio Hospital Association, said, "While the ruling is expected to increase demand for medical care, Ohio's hospitals are pleased it will allow nearly one million uninsured Ohioans to obtain better access to essential care in the most appropriate setting. While some provisions of the (Patient Protection and Affordable Care Act) merit further debate and amendment, Ohio hospitals believe leaving such refinement to future legislative action is a wise decision."

Congressmen Jim Renacci, a Wadsworth Republican, and Bob Gibbs, a Lakeville Republican, have already said they will vote to repeal the law, sometimes referred to as Obamacare.

Renacci and Gibbs said there are some good provisions in the law, but they would rather start with a clean slate and have a public airing of all of the provisions.

Some of the parts Gibbs likes include allowing children to stay on their parents' insurance policies until age 26, not letting insurance companies drop someone and establishing group risk pools at the state level. He is also a strong supporter of the Health Savings Account. He would like to see more personal responsibility, and tort reform and ability for people to purchase health insurance across state lines to increase competition.

State Sen. Larry Obhof, a Montville Township Republican, said there are about 400 different components of the law, and he would like to see Congress start with a clean slate and let each portion rise or fall on its own merits.

The health care reform law enacts many changes, said Snyder, some of which went into effect immediately and some that won't be implemented until 2014. Despite a definitive ruling of constitutionality, there are still many parts of the law that are yet to be determined, including what lawmakers and Gov. John Kasich will do to implement the federal mandate.

As Obhof sees it, Ohioans do not like the individual mandate. He sees the health care reform law as part of the reason Republicans made gains at the polls in 2010. In 2011, Ohio voters, by a 2-to-1, approved a constitutional amendment to not be a part of the federal government's individual mandate. He said he believes Ohioans will again reject the mandate at the polls in the general election this November.

Reporter Kelley Mohr can be reached at 330-674-5676 or kmohr@the- daily-record.com. Reporter Bobby Warren can be reached at 330-287- 1639.