June 30--PICAYUNE -- Dr. James Riser of Riser Medical Associates, who is celebrates 30 years of practice in Picayune on July 4, said on Friday that he does not think the Affordable Care Act, also known as Obamacare, will solve America's health problems, but the whole issue has a silver lining.
"Everyone is now talking about health care and the act will impact everyone," said Riser.
Highland Community Hospital Administrator Mark Stockstill said Highland still is not sure about what changes it will face in implementing the new law, but "we are ready to face the challenge and whatever it brings."
Riser said he is concerned most about quality of service falling further. "That is what we will have to work at," he said. "We once, when I first went into practice, were considered as having the best health care system in the world, but not anymore."
Additionally, Riser said that the health care act, which the U.S. Supreme Court ruled Thursday was constitutional, does not contain enough incentives.
Riser said the patient who follows all the rules and takes care of himself will wind up paying the same amount as the one who does all the bad things and doesn't follow his doctor's requests. "There's no incentives for being a good patient," he said.
"The U.S. spends more money on health care than any other nation, and we as health care professionals have to stay focused on quality of care, real quality, and not just throw money at problems," said Riser.
Stockstill said on Friday that he is taking a "wait-and-see" attitude on how the new health care law will impact Highland, after the U.S. Supreme Court's announcement on Thursday of its opinion, approving by a 5-4 vote most of the federal Affordable Care Act, or what some pundits call Obamacare.
The 5-4 decision meant that the law could pick up momentum as it approaches 2014 when it will take full effect. It will affect the way almost all Americans acquire health care.
"There are over 2,000 pages in the law," said Stockstill, "and that will result in thousands of new regulations, and I don't think anyone knows, right now, for sure what impact it will have."
Stockstill said he and his staff are waiting on information from the state hospital association that might help clarify how the act's approval by the Supreme Court will impact Mississippi's hospitals.
Stockstill said that he is concerned, especially, about the impact on the Medicaid program and is worried about what affect that program will have in Mississippi when the law takes full-effect in 2014. Twenty-two percent of Mississippi residents are on Medicaid. The program is for the poor, and Mississippi is the poorest state in the nation.
The Supreme Court ruling, besides approving the individual insurance mandate in the law, also said the federal government can't cut off all Medicaid funding to a state if the state chooses not to participate in an expansion of the program. The law has in it a formula that will allow states to increase the number of patients in the Medicaid program, thus generating more federal health dollars for the state. However, it will also cost the state more money, too.
Chief Justice John Roberts said Congress' ability to impose rules on Medicaid to the states has its limits. "In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement'-- it's a gun to the head," he said. As it currently reads, if the states don't follow federal instructions, the entire allotment can be cut. But that can't happen now after the court's Thursday ruling.
"They have already been implementing aspects of the law," said Stockstill, "but it's really fixing to go full force."
Highland officials are preparing to occupy a new, $55 million hospital in North Picayune in July, and are keeping close tabs on how the new law will impact their operation. The new hospital is owned by Forrest General Hospital in Hattiesburg, and is expected to revolutionize the way health care is delivered in Pearl River County and the surrounding area.
"One of the things we are worried about is Medicaid," Stockstill said. He said the hospital could lose money under the program.
He added, "We have kind of got a wait-and-see stance on this. We are waiting to see what comes down. We sometimes wonder, what with all the changes, how are we going to administer all of this? It's a scary time."
State Rep. Herb Frierson (R-Poplarville), chairman of the powerful House Appropriations Committee, said on Friday, "There is a lot that I still don't understand about the law, but I know this, that we can't increase the number on Medicaid. We just don't have the money. To do that we would have to cut other major programs or raise taxes."
He added, "I want to see the consequences that expanding Medicaid would have on the state before I do anything."
Frierson was in a Friday evening briefing in Jackson with representatives of the national state legislators association on the law's impact on Mississippi.
The main provision of the law was an individual insurance mandate, requiring residents who can afford it to buy insurance according to an income formula, and if they don't, a penalty (a penalty was what Congress and the law called it) would be assessed by the IRS on them at tax time. The Supreme Court said the penalty was actually a tax and was within Congress' taxing powers to implement. Justices said the commerce clause had nothing to do with the issue.
Said Chief Justice John Roberts' majority opinion: "The Federal Government does not have the power to order people to buy health insurance. . .It does have the power to impose a tax on those without health insurance. Section 5000A (the individual mandate) is therefore constitutional, because it can reasonably be read as a tax."
Roberts broke with the conservative judges and announced the court's ruling. Roberts defined the courts view of the mandate as a valid exercise of Congress' authority to "lay and collect taxes." Government experts estimate four million citizens will pay the penalty rather than buy insurance.
Obama and his supporters praised the court's ruling, and GOP candidate Mitt Romney and his supporters said they would repeal the law, if Romney is elected in November. Romney called it bad policy and bad law.
The Supreme Court's ruling brought an immediate response from Mississippi GOP leaders who said that Mississippi cannot afford to expand its Medicaid program to cover more people under the new federal law, but some Democrats said Mississippi "should jump at the chance" to provide coverage to its more than half-million uninsured, the Associated Press reported on Friday.
Gov. Phil Bryant on Thursday told the AP that Mississippi would have to make deep cuts in education and transportation to cover expenses for an estimated 400,000 new people that could go on Medicaid, a federal-state health insurance program for the needy.
Mississippi House Speaker Philip Gunn (R-Clinton) in a Friday statement said that the federal health care law could be "a budget-buster for the state." Lt. Gov. Tate Reeves, after saying it would cost the state $1.7 billion over 10 years to add 400,000 people to Medicaid rolls, added, "Mississippi taxpayers simply cannot afford that cost, so our state is not inclined to drastically expand Medicaid. True health care reform should look at reducing costs for services, not increasing the burden on taxpayers."
State Rep. Steve Holland (D-Plantersville), who was chairman of the House Public Health Committee before the GOP took over, said that Mississippi should take advantage of federal dollars and cover more poor people.
Said Holland, "We, among all states, have a higher percentage uninsured. The only thing that scares me with them (the GOP) in charge -- and there is no penalty for not expanding Medicaid -- is they'll say, 'We can't afford it'. I tell you what, I welcome that war. . .I want that debate taken straight to the people."
The current House Public Health chairman, Rep. Sam Mims (R-McComb) said, "We cannot afford to expand Medicaid, and we are going to do everything we can for that not to happen."
Here are comments from other Mississippi leaders:
4th District Congressman Steven Palazzo (R-Miss.): "The Supreme Court may have ruled to uphold the law for now, but that does not change the fact that it is bad for small business, bad for families, and bad for seniors. . .The very fact that 26 states brought suit -- and that only a third of the public supports this legislation -- tells me that we have good reason to keep working to repeal and replace the law. . ."
U.S. Sen. Thad Cochran: "I continue to favor repeal of this health care law. We should respect the fact that most Americans don't want it."
U.S. Sen. Roger Wicker: "Congress now has an opportunity to show the American people that we are listening to them by voting to repeal it and replace it with market-driven solutions that help lower costs."
Mississippi Insurance Commissioner Mike Chaney: "We are moving along in developing a health insurance exchange which will increase access to health insurance and help stabilize costs for small employers. I believe that we have acted diligently. The result is a state-based exchange which will prevent us from deferring to a federally-run exchange."
The Mississippi Hospital Assoc. released the following statement: "Some public officials have already stated Miss. cannot afford the Medicaid eligibility expansion provided for by the Act. As taxpayers and major employers in Miss., hospitals certainly understand and appreciate that position. However, failure to expand Medicaid eligibility will leave just under 200,000 Mississippians with no health care coverage at all. These Mississippians will be left in the gap -- not eligible for Medicaid and not eligible to purchase health insurance through the health insurance exchange. The result could be devastating. Hospitals cannot be expected to treat such a large volume of people with no expectation or prospect of payment for those services. The result could very well mean the closure of many of our community hospitals."
Statement of the Mississippi Health Advocacy Program: "Thousands of Mississippians have already benefited from the Affordable Care Act -- seniors are paying lower drug costs, young adults have been able to stay on their parents' insurance plan, and insurance no longer has lifetime limits and covers preventive care with no out-of-pocket costs. Also Mississippians will benefit from reforms that will be implemented in 2014 when no one can be denied coverage. While the court's decision raises questions around changes to Medicaid eligibility, the need to provide multiple health insurance options to Mississippi families remains an important element in providing affordable health insurance to Mississippians."
Forest Thigpen, president of Mississippi Center for Public Policy, issued the following statement: "This is a stunning expansion of the government's power over our lives. It violates the principles of our nation's founders. . . Markets work better than mandates. Having the government tell people what to do never works. What works is for people to have the freedom to make their own decisions. If a true free market existed in health care, costs would be lower and more people would be covered by affordable health insurance."
The U.S. House has scheduled a vote on July 17, hoping to repeal the law, and that vote is expected to be in favor of repeal, but it is given little chance of getting by the U.S. Senate or a presidential veto.
(Dispatches from the Associated Press were used in the compilation of this report.)
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