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Local figures react to healthcare ruling

Ocala, FL - June 28, 2012

Marion County's largest health care facilities say they are still uncertain how the Supreme Court's ruling Thursday upholding virtually all of President Barack Obama's health care overhaul will affect them or their financial bottom line.

Officials at the publicly owned, not-for-profit Munroe Regional Medical Center, and at Ocala Health System, which owns the for-profit Ocala Regional Medical Center next door, both said in written statements they'll work with government and health care officials to sort out the law's impact on their businesses.

"We are hopeful that following the Supreme Court's decision today, that most of the 84,000 uninsured Marion County residents will be provided with health insurance coverage by 2014," said Munroe's president and CEO, Steve Purves, in an email. "While the debate in Washington drags on, Munroe will continue to advocate for policies that support our goal of improving access to care, providing high quality services and reducing costs."

Ocala Health System also sent the Star-Banner an email.

"It's too early to tell what impact the Supreme Court's decision to uphold the Affordable Care Act will have on the way Ocala Health System provides patient care," wrote Randy McVay, the system's CEO.

"Healthcare is a shared responsibility, and for our part, we will continue to focus on the quality of care we provide patients in Marion County. We will work with our stakeholders — clinicians, government authorities, community leaders and employees — to ensure the provision of this care continues smoothly."

He concluded: "We are pleased that our community — and millions of Americans — will have coverage for better access to vital medical services, preventive care, and acute care.

Paul Duncan, from the University of Florida's Center for Medicaid and the Uninsured, said although thousands of administrative decisions will have to be made to implement the health care law, providers benefit when more patients walk through their doors with some sort insurance.

"Three million Floridians who don't have insurance, would have insurance" once the president's plan is in place, Duncan said. "The number of uncompensated cases would go down and the number of patients (able to pay something) would go up."

Of the 3 million newly insured, about half will get their insurance through employers or buy it through state-overseen exchanges, Duncan said. The other half will be added to an expanded Medicaid program.

How much money newly insured patients will bring hospitals that otherwise would have treated them for free as indigent cases is unknown, Duncan said.

"But they (hospitals) are going to benefit," he said.

It's also uncertain how much the expanded Medicaid program will cost Florida taxpayers, because it's uncertain how many people will use it.

"That's driven by how robust the economy is. If the economy is good, few people will be on (Medicaid)," he said.

What is likely, Duncan said, is that employees who don't have health insurance and face federal fines if they don't buy it will put pressure on employers to start offering coverage.

Ocala Health Systems in 2011 provided care to 32.5 percent of the indigent market share, or about 17,000 patients. Munroe Regional provided care for just about all the other indigent cases.

Kerrie Jones Clark, executive director of Heart of Florida Health Center, the not-for-profit that serves mostly the poor, said the health care law will allow more of the center's patients to have insurance coverage. As a result, Heart of Florida will have more paying patients.

Heart of Florida had about 22,000 patient visits in 2011, 5 percent of whom had private insurance and 35 percent of whom had Medicaid or Medicare coverage. The rest had no insurance.

"Anything that improves access to health care and insurance, which is the biggest thing that improves access to health care, is a good thing," Clark said.

Florida could opt out of the expanded Medicaid program. But since there are so many residents who need the help, Florida could feel pressured to join and get the federal money, Clark said.

Paolo Annino, clinical professor and co-director of the Florida State University Public Interest Law Center, called this "one of the major decisions in American jurisprudence."

Whether Florida decides to buy into the idea of expanding its Medicaid program remains in question — especially since the state led the pack of 26 states that were against the health care law.

If Florida chooses to expand Medicaid, "the federal government will provide 100 percent of the extra funding to cover these poor people," Annino said.

"That's (increased Medicaid funding) going to put state leaders on the spot, I think," said Michael Allen, a law professor at the Stetson University College of Law.

Gov. Rick Scott and Attorney General Pam Bondi said they were shocked and disappointed by the Supreme Court's decision, but reserved saying anything official about the ruling, according to press reports.

Reactions from three members of Marion County's delegation in the U.S. House:

• Cliff Stearns, R-Ocala: “Although I'm deeply disappointed by this Supreme Court decision, the fight now moves to repealing Obamacare, which means we must defeat President Obama and assemble majorities in the House and Senate to carry out the people's will.

“The American people now will face a massive tax increase that started as a mandate, and the tax will fall disproportionately on the working class.”

• Richard Nugent, R-Brooksville: “The Supreme Court ruled today that although the federal government does not have the constitutional authority to force you to buy health insurance, it does have the authority to levy a tax penalty on you if you do not.

“In other words, the federal government can't force you to do something, but they can compel you to do something through their power to tax you. In my mind, there is virtually no meaningful difference between those two. What's next? Where does the power end?

• Corrine Brown, D-Jacksonville: “This is a great day for the United States of America and millions will celebrate the decision, but we cannot rest. Some in Congress do not believe the government should be involved in expanding access to healthcare. Americans who have come to rely on the wide-ranging and life-saving benefits of the Affordable Care Act must tell those politicians how they feel.

“Come November, people will remember Obama cares!”

Dr. Jaime Rubio examines Joao Brasil at the Heart of Florida Health Center Wednesday afternoon, January 25, 2012 in Ocala, FL. The Heart of Florida Health Center will later this year take over the role of providing primary healthcare for Marion County Health Department patients. The new role, which includes providing healthcare to the health departmentís 20,000 patients by October, is the result of a new partnership between the two agencies, said Dr. Nathan Grossman, the health department's director. "We still have a lot to work out," Rubio said.Doug Engle/Ocala Star-Banner


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