Health care overhaul fuels debate among mid-state doctors [The Patriot-News, Harrisburg, Pa.]

June 29--Dr. David Scher was no cheerleader for the Affordable Care Act. Yet he cheered the U.S. Supreme Court decision to let it stand.

It might only amount to a Band-Aid for a badly broken health care system, but it's a bridge to something better, he said.

"If this would not have held, it would have set us back tremendously in changing anything in health care. I think if this didn't happen, it would really be a total disaster," said Scher, a former cardiologist in the Harrisburg area who is now a consultant.

But while the 5-4 ruling Thursday settled a legal argument, it didn't quell the fierce debate over the Affordable Care Act, widely known as Obamacare.

Detractors fumed, saying it's the wrong approach to fixing health care and predicting it will either be repealed or collapse under its own financial weight.

Harrisburg area supporters of the law celebrated, hailing it as the beginning of the end of the problems of tens of millions of Americans with no health insurance.

"We are thrilled," said Jeannine Peterson, CEO of Hamilton Health Center in Harrisburg. "It takes an uninsured person and makes them into an insured person."

Hamilton is a federally-funded health center which serves about 20,000 people annually. About 30 percent have no health insurance, Peterson said.

Many of the people who end up there have long gone without regular and preventive health care. Now, with health insurance, they'll get better care and their health care costs will eventually go down, she said.

Harrisburg-area surgeon Dr. Bret DeLone didn't share such optimism.

"I still think it's bad policy," he said.

One of his concerns centers on expanding Medicaid to cover people who earn up to about $29,000 for a family of four.

The costs of Medicaid are shared by the federal government and the states, and it already accounts for a huge chunk of the budget in many states, including Pennsylvania. The federal government will fully fund the expansion at first, but gradually shift more of the cost to the states.

DeLone predicts Pennsylvania will eventually have to choose between Medicaid and adequately funding things like education and highways.

He also feels the law appeased too many special interests while failing to tackle the real forces -- such as lack of competition and skewed incentives for both provider and patients -- which are to blame for out of control health care costs.

"This law is not necessarily bad for my industry. I think it's bad for my patients," he said.

Thankful for 'clarity'

Harrisburg-area hospitals and insurers were reserved in their responses, neither jumping for joy nor predicting doom and gloom.

Leaders of both PinnacleHealth System and Penn State Milton S. Hershey Medical Center said they were thankful for the "clarity" resulting from Thursday's ruling.

Local hospital leaders stressed they are implementing aspects of the of the Affordable Care Act, including greater collaboration and coordination among health care providers.

Asked whether he expects the Affordable Care Act will succeed in covering the uninsured while also being financially sustainable, Dr. Harold Paz, CEO of Hershey Medical Center, said: "I think it's very important to ensure we do everything we can do to make sure that every American has access to health care."

"I'm very optimistic that if people take the opportunity to obtain the insurance and utilize the services that are covered, the health of the country will improve," Rick Schaffner, a senior vice president at Holy Spirit Health System, said.

In addition to the Medicaid expansion, the Affordable Care Act will use government subsidies to help people afford health insurance.

Subsidies, on a sliding scale, will be available to people earning up to about $88,000 for a family of four. Small businesses will also receive government help.

In addition, states will create "exchanges" designed to help people and businesses shop for coverage.

People who refuse to obtain coverage, and businesses with more than 50 people that don't provide health benefits, will be fined.

More insurance customers

The law is expected to result in many new customers for health insurance companies, and better-insured customers for hospitals.

Dr. Donald Fischer, chief medical officer for health insurer Highmark Inc., said Highmark will offer coverage available through the exchanges, and expects the law will result in more customers.

"This isn't just a win for insurers. This is a win for providers that are seeing people who aren't covered ... It's a win for consumers -- ultimately 50 million people in this country don't have insurance, and that leads to poor health," he said.

Still, he said more effort is needed -- preferably through private forces rather than legislation -- to change consumer behavior regarding their health and use of health care, and to spur higher quality among medical care providers.

Like most health insurers, Capital BlueCross was pleased the court didn't strike down the individual mandate while leaving alone the provision that bans insurers from rejecting people or charging them substantially more because of pre-existing conditions.

In the weeks leading up the decision, Capital had argued that without the mandate, it would be financially unsustainable to accept all pre-existing conditions.

Now, Capital is prepared "to move full speed ahead" in complying with the law, said Aji Abraham, Capital's vice president of government affairs.

Capital has begun promoting Affordable Care Act components such as a "medical home" intended to take a more proactive approach to helping people manage chronic illnesses and keep them out of the hospital, he noted.

Dr. William Wewer, a Steelton family doctor, has long been troubled by the number of people who avoid medical care because they can't pay for it.

He was worried the court would strike down the Affordable Care Act, even though he views it as less than perfect.

"The uninsured population should become smaller ... that is if the politicians don't step in and mess it up," he said. "I'm glad it held up, because it's a least a small step toward getting those millions of patients at least something."

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