By Mark Boshnack
With the Supreme Court decision on the constitutionality of President Barack Obama's Patient Protection and Affordable Care Act possibly days away, local officials in health care and related fields considered the possible effects Tuesday.
The Supreme Court has several options when it announces its decision, which is expected Thursday. This includes deciding the constitutionality of the individual mandate that requires citizens to have health insurance or pay a fine. If the justices rule against it, the whole law could be overturned.
"The immediate impact (of such action) will be much more political than practical," Bassett Healthcare Network Chief Executive Officer Dr. William Streck said.
The cuts needed to help fund the changes under the 2010 law are already in place, he said. Nationally, hospitals have agreed to $155 billion in Medicare cuts over 10 years cuts to support the legislation.
It would be balanced by additional coverage for those previously uninsured.
If the court leaves part in place, while making changes, one of the possible outcomes is the cuts will remain and the insurance will never be completed, he said.
"I would be very surprised if they threw out the whole law," but in the current political climate, Streck said he is not as certain as he once was.
"The changes (under the law) already in place have had a profound impact," he said. This includes such provisions as letting children stay on parents' policies until age 26, and providing insurance even with pre-existing conditions.
"Those won't be taken back. Politically, that will be impossible," he said.
In this economy, there are factors at work beyond the Affordable Care Act that demand the health care system become more efficient and less costly. It is as much market-driven as anything, he said. The Bassett Healthcare Network is the result of that. "We have a long way to go, as does the country," Streck said.
The impact will depend on how the court acts, Kay Stuligross said. The county representative is also the board president of the Friends of The Oneonta Community Health Center. The organization provides free primary care to low-income adults without insurance who meet financial criteria.
There are parts that have been implemented and are already making a difference in people's lives, Stuligross said.
"It can be a life-and-death matter for people that are newly covered," she said.
Dr. Ben Friedell is vice president of medical affairs at A.O. Fox Hospital.
"Having practiced health care for 30 years, it's clear to me the system is broken and needs fixing," he said. As imperfect as the reforms are, "it's a major step forward in trying to fix the problem in delivering and financing health care in the United States."
If all, or a major part, of the act is overturned, including the individual mandate, "it will be a significant setback to health care."
Many of the law's provisions, such as insuring pre-existing conditions or keeping children on the policy are popular, he said. "Almost all of us know someone who qualifies." Because of this "many people opposed to Obamacare think that is a good thing."
Friedell said he is a proponent of single-payer health care system, in which a single agency organizes health care financing, but delivery of care remains largely private.
"I firmly believe that is the only way we can have adequate health care," he said. If the Supreme Court turns down all or major parts of the law, "it will speed up the process towards that."
"A system that spreads the risk over the entire population is the only way to deal with issues such as cost and quality," he said.
Springbrook Executive Director Patricia Kennedy said that health care reform is important. The agency provides residential, educational, therapeutic and other programs for people with developmental disabilities.
"We have to transform the system, and this is the beginning of it," she said, adding that the individual mandate is a key component of it.
Without it, the system runs into problems providing care for people with preexisting conditions, including those with disabilities, Kennedy said.
The health care law does some good things including providing for care coordination -- making sure all the pieces in the system are working together, she said.
That is something done at Springbrook and is important to do for all people to make sure health care is affordable, she said.