Workers expect their defined contribution plans to play a greater role in their retirement income than annuities.
June 28--Implementation of the health-care reform law held up for the most part by the U.S. Supreme Court Thursday will be a mixed bag in Kern County, local health officials said after the landmark decision.
"There are wins and losses in it," said Jarrod McNaughton, a vice president at San Joaquin Community Hospital.
On the win side, more insured users equals more payments for the health system and expanded coverage for the county's residents. But it comes at a price: dramatically reduced DSH funding, federal money given to hospitals that take care of a disproportionate share of non-paying patients.
While more people will be covered under Medi-Cal, those reimbursements are often far less than the actual cost of hospital care, he said. Only time will tell if the expanded volume of insured patients will compensate for the projected cuts in Medicare and DSH funds.
"We're not one of the wealthy counties," McNaughton said. "We're very much on the frontline of seeing a high proportion of indigent care."
In addition, hospitals will still be required to take care of uninsured who come through their emergency room doors -- such as illegal immigrants who won't be covered under the reform.
Another Kern-specific challenge will be bringing more primary care doctors to an area that already struggles with physician recruitment, added McNaughton and Jacey Cooper, the program director of the Kern Medical Center Health Plan.
Cooper said she was relieved to hear Thursday's decision, which will allow her to keep implementing the so-called bridge to reform program in Kern.
"There's a lot of work to be done, but I think it's very valuable for all of Kern County," she said. "All of the work we're doing will keep moving along."
Cooper has been working with the Medi-Cal expansion aspect, which could eventually provide coverage for anywhere from 15,000 to 25,000 Kern County residents. As part of the bridge, the county has already expanded coverage to 6,500 people currently in that program.
For a county that struggles with high numbers of uninsured individuals, the move will eventually mean better care and cost savings, she predicted.
On the business side, the dean of Cal State Bakersfield's School of Business and Public Administration, John Emery, said the decision will impact different businesses differently but that overall, "I don't think it changes the investment climate."
Emery pointed to potential benefits for employers, saying some may choose not to offer health benefits directly to their workers and instead contribute to regional health networks. He said that adds flexibility and could save some businesses money.
In another possible benefit for business, he said, private health insurance premiums are likely to be less reflective of the extra costs hospitals now face when caring for uninsured patients.
"I guess one way to put that," he said, "is that the overcharging or overpricing to people or organizations that have health care coverage already will probably go down."
Political reaction to the Supreme Court's decision also poured in Thursday morning.
Congressman Kevin McCarthy, R-Bakersfield, noted he voted to repeal so-called Obamacare and wants the chance again.
"The Court's ruling makes one thing clear -- it is up to Congress to act to repeal the impending health care tax increases on American families," he said in a statement. "That is why my Republican colleagues in the House and I will move forward to fully repeal Obamacare in order to prevent further harm to our economy, job creation and the cost and quality of care. More than two years after its passage, healthcare costs have gone up and millions of Americans are at risk of losing their current coverage."
The local chapter of the Service Employees International Union hailed the decision as "promising every single American a better future."
"It is a resounding victory for working people and for the more than 100 million Americans of all political parties, ages, incomes and occupations who are benefiting from the Affordable Care Act," the union said in a statement.
It quoted Sharon Ingram, a staff nurse at Kern Medical Center, as saying: "This is the best thing that could have happened for our country. This is a big win for the American people. And I am really, really proud of all the nurses and everyone who helped to make this happen."
The National Republican Congressional Committee used the ruling to argue against re-electing Rep. Jim Costa, D-Fresno, to Congress. Costa voted for the health-care reform law, but early on had advocated for a more piecemeal approach to changing the health-care system:
"After today's Supreme Court decision, the only way to repeal Jim Costa's government takeover of healthcare is to fire the Democrats who created it," the NRCC said. "Costa's government takeover of healthcare remains a massive roadblock to California families taking control of their healthcare and to small businesses trying to create jobs."
California Sen. Barbara Boxer, a Democrat, touted the benefits of the law and vowed to fight Republican efforts to repeal it.
"The decision is great news for the millions of Californians who have already seen the benefits of this law -- including the six million who now have access to free preventive health services, 355,000 young adults who now have coverage on their parents' health plans and 320,000 seniors who have received help in paying for their prescription drugs," Boxer said in a statement..
"Now Americans will have the certainty of knowing they won't be denied coverage because of a preexisting condition. Women won't be charged a higher premium because of their gender. And families struggling with serious illnesses will not face lifetime limits on coverage."
-- Government editor Christine Bedell contributed to this report.
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