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Some local community health leaders were surprised — but happy — about Thursday’s Supreme Court decision to uphold President Barack Obama’s Patient Protection and Affordable Care Act.
“In theory, the act is trying to ensure that more children are covered, and that’s a good thing,” said Lawrence G. Duncan, CEO of El Paso Children’s Hospital. “If more patients are covered by insurance, the better off we are.”
But he also offered a caution.
“While it is good for patients and specifically children to get additional insurance coverage, it does not expand the overall pool of Medicaid dollars,” Duncan said. “The money will need to come from somewhere, and my suspicion is it will be from the rates paid to physicians and hospitals.”
The Supreme Court ruled 5-4 that the Obama administration’s Patient Protection and Affordable Care Act was constitutional. Chief Justice John Roberts joined the majority opinion.
“El Paso is one of the top 100 poorest communities in the United States where one out of every three El Pasoans is uninsured,” said Dennece Knight, executive director of the University Medical Center Foundation. “That means every third car you see driving down the freeway, every third person in the grocery line is grappling with the issue of ‘what if.’ Any solution that covers more people is a good solution.”
The major debate centered on the individual mandate, which requires the overwhelming majority of Americans to have health-care insurance or face a financial penalty, unless exempted due to religious beliefs or to financial hardship.
Several provisions of the 2010 act are already in effect, and the entire law will take effect in January 2014.
“Today’s decision is an incredible victory for the nearly 30 percent of El Pasoans, the 5 million statewide, and the 1.2 million Texas children who lack health insurance,” said state Sen. José Rodríguez, who is a member of the Senate Committee on Health and Human Services. “I applaud Chief Justice Roberts for making the right decision to uphold the individual mandate and putting the Constitution above partisan politics.”
Roberts, a Republican appointee, joined Associate Justices Stephen Breyer, Ruth Ginsberg, Sonia Sotomayor and Elena Kagan to give President Barack Obama a majority backing the health care law.
The law also forces insurers to cover people with pre-existing health conditions. The court limited the law’s extension of the Medicaid program for low-income people by saying the federal government cannot threaten to withhold money from states that don’t fully comply.
In a statement, outgoing U.S. Rep. Silvestre Reyes, D-El Paso, said he was proud the Supreme Court upheld the individual mandate.
“This historic legislation came at a crucial time for our city with over 230,000 people uninsured in 2009,” he said. “When the new law is fully implemented in just a few years, El Pasoans who now lack health insurance will receive coverage — many for the first time.”
Under the act, insurance companies cover recommended preventive services, including mammograms, colonoscopies, immunizations, and prenatal and new-baby care, without charging deductibles, co-payments or co-insurance.
“So far, 90,000 El Pasoans have benefited from this change, including 26,000 children and 33,000 women,” Reyes said. “This legislation has also provided new tax credits to approximately 360 small businesses in El Paso to help maintain or expand health care coverage to their employees.”
Republican Congressman Francisco “Quico” Canseco, whose district covers the far east edge of El Paso County, called the high-court decision disappointing for American families, seniors and small businesses.
“If we do not repeal it, Obamacare will leave Americans with more expensive and lower quality health care,” he said. He added that Washington, D.C., not patients or doctors, would be in charge of health care.
Canseco said the Patient Protection and Affordable Care Act could threaten access to health care by seniors because of the more than half a trillion dollars in cuts to Medicare to pay for it.
Dr. Barry Cromer, an orthopedic surgeon with the El Paso Orthopedic Surgery Group, is concerned about the effects the law will have on doctors.
“Ultimately, private insurance (companies) are going to have to make major cuts to the point where private physicians are going to drop out of their network,” he said. “Then there’s going to be a large influx of people who are going to be dropped from coverage from their employers and they’re going to end up with a Medicaid equivalent (of health care).”
Cromer said the act would create a two-tier health care system in which people who pay for health care will get the best health-care services while those who can’t afford good health care will end up in government-run county hospitals.
“From a doctor’s stand point, there’s going to be mandated decreases on all fronts,” he said. “Eventually, the doctors will either stop participating with the private insurance companies or they’ll end up working shifts at a hospital.”
Centro de Salud Familiar La Fe — given its 45 years as a social justice, health and human services organization — has a deep understanding of the issues of the El Paso uninsured.
“When you get down to the bottom line, the Affordable Care Act is not going to change the reality of this community’s tremendous number of uninsured, under-served and medically underrepresented people,” said Estela Reyes, the spokeswoman for La Fe. “The reality is, this law, as great as it is and as happy as we are as a nonprofit organization to see it upheld, it’s not going to solve everybody’s problems.”
Jorge Salazar, administrator of community health programs for La Fe, agrees.
“At La Fe, through the work of (CEO) Salvador Balcorta, we have been trying to get a comprehensive medical coverage law passed where all people will have access to the level of health care they deserve,” Salazar said. “We don’t see that in this version of the Affordable Care Act. But the Supreme Court decision is a huge step in recognizing that access to health care is based on a system in which you need to have a certain level of insurance.”
Dr. Jose Manuel de la Rosa, vice president for health affairs at Texas Tech University Health Sciences Center and the founding dean of the Paul L. Foster School of Medicine, said the school is pleased the Supreme Court has upheld the critical parts of the Affordable Care Act.
“This is an important step for improving health care for all of us,” he said. “The research we perform within our own school specifically addresses problems of our population and attracts physicians and researchers alike from across the country.”
De la Rosa said that to continue this momentum, he would like to urge Congress to move quickly to “provide federal support for additional doctor training by funding more residency and fellowship programs in order to ensure that the border has access to care — not just an insurance card.”
Victor R. Martinez may be reached at firstname.lastname@example.org; 546-6128. Follow him on Twitter @vrmart.