Businesses work to get details out [Daily News, Bowling Green, Ky.]

June 29--In the wake of the Supreme Court's ruling Thursday upholding most of the historic Affordable Care Act, local and state organizations and businesses are striving to help people understand how this is going to affect them.

Chris Keyser, executive director of Fairview Community Health Center, said the facility serves an average of 10,000 people annually, many of whom are uninsured or underinsured. Thursday's mandate upheld everything except how it will deal with states that don't expand their Medicaid coverage.

Kentucky is ready to move ahead to create a statewide health insurance exchange, Gov. Steve Beshear said Thursday.

"This Supreme Court decision removes much of the uncertainty about the Affordable Care Act," Beshear said in a statement. "Kentucky has been systematically preparing to meet the implementation deadlines set forth in the bill as a precautionary matter."

The health care act will add 300,000 Kentuckians who can't afford health insurance to the Medicaid program, officials say.

Expanded Medicaid insurance will be important to many people, particularly men, Keyser said.

"Pregnant women and children have insurance through the Medicaid program, but for working males who do the best they can to support a family, there is nothing," she said. "They should be under the umbrella of Medicaid expansion. There should be some options for them as well."

The center's role will be encouraging people who qualify to apply for the services they need, which may include going to an office or online options, Keyser said.

"We want to help people enroll as quickly as possible so they can have a health care provider assigned to them," she said. "We're looking forward to some of those people to get insurance through expanded Medicaid insurance."

Jodi Mitchell, executive director of Louisville-based Kentucky Voices for Health -- organizations and individuals working to improve Kentuckians' health and health care coverage -- said "it's a great day for Kentucky as consumers of health care services.

"This will make it more consumer friendly. There's a lot to be implemented, still a lot of information of what's in the law," she said. "We need individuals to take ownership for their health care. Then there's transparency, more focus on health and wellness."

Some are against it, but change is difficult all the way around, and with change comes fear, Mitchell said.

"There's not a law that's ever perfect," she said.

Terry Brooks, executive director Louisville</location>-based Kentucky Youth Advocates, sees the reform as a good thing for Kentucky's children.

"If there is a part that we can agree on, it's about kids. There are multiple provisions in the Affordable Care Act that are common sense for kids," he said.

Some of them have gotten attention, including the portions that allow youths to remain on their parents' health insurance coverage until age 26, and the health care law spells the end of insurance companies denying coverage to children with pre-existing conditions. Other issues that haven't gotten as much attention have "Kentucky written all over them," Brooks said.

"Two major problems that confront Kentucky kids is the lack of preventative care and the really bad conditions for oral health," he said.

To avoid co-pay expense, parents often take their children to an emergency rooms, Brooks said. Getting preventive care will help keep this from happening. Then well-child, vision and dental screenings won't seem like a luxury.

"This is support for those regular, annual, are-you-doing-OK checkups," he said. "In the long run, it will not only help kids, but save the state money."

The act could help foster children get Medicaid until they're 25 instead of 19 as it is now, provide seed capitol for school-based services to reach children where they spend the most time and get outreach for families for services that they may not know they are eligible for, Brooks said.

"There are still thousands of kids eligible and not signed up. This gives them the incentive and resources to tackle that," he said.

Brooks said it's important to see the ruling as a wake-up call, and that 2014 isn't that far away.

"Folks in Kentucky and Frankfort need to start asking the question, 'Now what? What are we going to do across the commonwealth?' "

Murry Raines, a partner at the Bowling Green law firm English, Lucas, Priest and Owsley, said the act requires people who do not obtain health insurance to pay a penalty, or a tax.

"The Supreme Court upheld that part of the act, saying that Congress had the right to under the taxing granted in the Constitution," he said. "They didn't have the right to do that under the Commerce Clause. That would've been unconstitutional. They upheld, but as a tax."

Medicaid is funded by states and partially by the federal government, Raines said. The Supreme Court deemed that the expansion of the program could advance as long as the government didn't threaten to hold states' whole allotment for not participating in the expansion.

"The act was going to expand their Medicaid coverage to people who were not previously covered under Medicaid. If not, (the states) would lose all their funding," he said. "Congress said that was unconstitutional. There may be some other legalization about the act, but it will be a political issue, not a judicial issue."

Representatives of two local insurance agencies agreed that having insurance is a necessity, but a lot of questions about the act remain unanswered.

Houchens Insurance Group account executive Mallory Pendleton and president Bryne Wiseman said that one of the items that has not been discussed is how this will affect employer groups who may decide not to offer coverage because the penalty is cheaper than offering insurance.

"If you have under 50 employees, the employer can drop health care altogether without any penalty," Wiseman said. "If they have over 50, they can pay $2,000 a year fine to the government, and that forces employees to buy insurance on their own."

The company has been asked about affordability, Wiseman said.

"We really don't know how it's going to affect everyone here," he said. "There are going to be companies talking to us every day and paying the fine and walking away.

"The root cause has not been solved. We think everybody needs coverage, but they did not do anything to decrease the cost of coverage," Wiseman said.

Pendleton agreed.

"How are we controlling cost?" she asked. "What are we doing to get to the root of the problem?"

Individuals may be just as likely to pay the penalties as companies.

"It's not a sufficient type of penalty to affect the way they buy insurance. The first year it will be the greater of one percent of your gross annual income or $95," said Stephan Scott, owner of Diligent Health. "I think they're going to have to tweak it."

The individual mandate will help keep costs down by having everyone pay into the system. If the population is healthy, the premiums go down. If the population is not healthy, the premiums go up, he said. People who may not have qualified for insurance before will be given credits on a sliding scale based on their income, Scott said.

"It has expanded a whole lot," he said. "It goes up to 400 percent of the poverty level."

Scott believes that piece of the legislation is good.

"You've got to be responsible. It's going to require everybody to be responsible," he said.

The Associated Press contributed information to this report.

According to the White House website, whitehouse.gov/healthreform, the Affordable Health Care Act:

-- Lets young adults stay on parents' insurance until age 26

-- Ends insurance company power to cap the amount of care a person can receive in a lifetime

-- Stops insurance companies from canceling coverage when someone gets sick

-- Lowers the cost of care for those on Medicare and helps seniors save money on their medication

-- Requires insurance companies to cover preventive services like mammograms and colonoscopies free of charge

-- Strengthens and protects Medicare by increasing penalties for fraud

-- Stops insurance companies from denying coverage to children with pre-existing conditions

-- Ends insurance company power to raise rates without justification

-- Provides Americans with rebates from insurers who spend too much on CEO bonuses or ads

-- Gives tax credits to small business owners so they can afford to offer health care for employees

-- Builds and improves hundreds of community health centers

-- Gives tax credits so they can afford insurance beginning in 2014

-- Prevents insurance companies from charging women more than men and overcharging those who need care the most beginning in 2014

-- Creates state-based marketplaces where people can compare and shop for insurance beginning in 2014

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