The U.S. Supreme Court's 5-4 ruling that upheld the Affordable Care Act's mandate on individual insurance coverage by 2014 was received in Westchester and beyond with praise mixed with sharp criticism, business-as-usual shrugs and warnings of reform work yet to be done. With the landmark ruling behind, many in the health care and insurance industries said they are focused on the details of the state health insurance exchange taking shape this year.
In the wake of the long-awaited ruling, "I think it's sort of business as usual," said St. John's Riverside Hospital spokeswoman Denise Mananas in Yonkers. "We were working toward (implementing) the law as though it was going to be upheld."
"Since Thursday (when the Supreme Court ruled)," said James D. Schutzer, an employee benefits consultant and vice president at J.D. Moschitto & Associates Inc. in White Plains, "I've received dozens of calls from clients asking, 'OK now, the law was upheld, what do we need to do?"
Schutzer said businesses will need to look at their employment structure in relation to the law's group insurance coverage mandate for employers with 50 or more full-time equivalent employees. "I think employers are now starting to say, 'Oh boy,'" he said.
At the Suburban Hospital Alliance of New York State, which represents 51 Hudson Valley and Long Island hospitals, President and CEO Kevin Dahill in a statement called the court decision "a victory for the millions of Americans who currently do not have access to health insurance or cannot afford it. The ruling preserves the legislation's delicate balance between the needs for a robust and competitive insurance market, financial stability for health care providers and affordable coverage for consumers."
Dahill, though, cautioned that the Affordable Care Act is "an enormously complex statute" and its success is largely dependent on how New York and other states set up their insurance exchanges.
At The Business Council of New York State in Albany, President and CEO Heather Briccetti dismissed the Supreme Court decision as having "little immediate impact on the health insurance issues affecting New York state employers." Nothing in the ruling "helps 'bend the cost curve' or addresses the issues driving health care costs and utilization in New York state, which make the state one of the most expensive health insurance markets in the nation and a tremendous burden on large and small employers," she said.
Briccetti and others commenting on the court ruling noted that New York already has adopted a number of mandated reforms and expanded Medicaid coverage that are part of the Affordable Care Act. "Unlike many of our sister states, we have already seen how dozens of mandates have dramatically driven up costs and limited choice in the marketplace in our state," Briccetti said.
The Business Council will work to ensure that New York's health exchange is developed with input from insurers, agents, brokers, chambers of commerce and employers, she said.
At the New York Health Plan Association in Albany, which represents managed health care plan insurers, President and CEO Paul F. Macielak said New York's individual, direct-pay market - which the health exchange will reform - "is seriously broken" and the high-court ruling "will stop the existing death spiral." He noted the ruling keeps in place "much-needed" federal subsidies to help small businesses and individuals purchase insurance.
"In terms of insurance reform, we probably won't see a tremendous amount of change" in New York, said Leslie Moran, senior vice president at the state Health Plan Association. "What we believe New York needs to be looking at is truly reforming the health care system and putting the affordable in the Affordable Care Act. Nothing to date has really addressed the affordability issues."
In the wake of the Supreme Court ruling, the Westchester County Medical Society issued some of the most forceful criticism of the law that justices by a narrow margin upheld.
In an editorial letter, Dr. Thomas T. Lee, president of the county society, said the methodology used under the law to achieve the laudable goal of universal coverage is "unrealistic and unsustainable." Fully implementing the Affordable Care Act "will harm access to patient care," he said.
In a webcast hosted by the Westchester County Association, Keith Safian, president and CEO of Phelps Memorial Hospital Center in Sleepy Hollow, said while the court ruling "at least gave us some clarity about going forward," the insurance mandate does not apply to the illegal immigrants that make up a sizable part of the county's labor force and are regularly treated at Westchester hospitals.
While losing money treating uninsured patients, hospitals also are inadequately reimbursed by the government for Medicare and Medicaid patients, Safian said. And health care providers face an additional $150 billion in Medicaid cuts as part of the Affordable Care Act, he said.
Schutzer said insurance brokers at firms like his question whether their services will be needed by individuals and small businesses shopping in the state health exchange.
"Now more than ever, our clients need us," he said. "There are so many regulations coming through in the next 18 months, our role has changed. It has changed forever. I like a new role."
"It's full steam ahead," Schutzer said.