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Politicians commandeered most of the spotlight by weighing in on Thursday's Supreme Court decision to uphold the bulk of the Affordable Care Act, but reaction from health care providers, business owners and others was seemingly just as polarizing and intense, if less visible.
In Washington, D.C., where hundreds of supporters and protesters gathered outside the Supreme Court building, Tea Party supporter Susan Clark, a retired hairdresser from Santa Monica, Calif., was decked out in an American flag, red pom-pons and blue-and-gold hat. "I'm old. I remember what health care was before the government and lawyers got involved," Clark said. "You could go to the hospital and you didn't go bankrupt."
Nearby, Shamequa Obee was among those holding signs in support of the mandate. "I have diabetes," said the 19-year-old resident of suburban Temple Hills, Md. "What am I going to do without health care?"
Business owners appear just as split. For Mark Hodesh, owner of the Ann Arbor, Mich., garden supply store Downtown Home and Garden, the court decision was a cause for celebration. He has been able to offset 35% of the costs of providing health insurance to his 13 employees with $20,000 in federal tax credits over the past two years. Having health insurance "gives my employees the long-term security to make investments in houses" and other things without having to worry about being financially wiped out from one visit to the emergency room, he said.
But Mike Geygan, owner of Minuteman Press in Lebanon, Ohio, says he isn't sure whether he'll continue to provide health insurance coverage for his 12-employee shop — which now costs him about $36,000 a year.
"It's a mess," he said. "It just makes it really hard for businesses to plan."
Although Geygan acknowledges that something has to be done to curb escalating costs, he's afraid increased government oversight isn't the solution. "I'm firmly convinced that, long term, anything government is involved in will be a disaster," Geyan says.
But Doug Ulman, president and CEO of the Lance Armstrong Foundation, said the court ruling means cancer survivors won't face discrimination from insurers for pre-existing conditions.
"Today, cancer survivors throughout the U.S. are celebrating,'' Ulman said. "Parents of young cancer survivors will continue covering their kids on their insurance until they are 26.
Life-saving preventive services, like breast and cervical cancer screenings, will be covered with no co-pays or deductibles. The Affordable Care Act's lifesaving measures, so critical to cancer survivors and their families, will be preserved, and we are enormously relieved."
Cancer patient Brian Rose, a coach with the Wingnuts, a Wichita minor-league baseball team, is one of the beneficiaries. Three years ago, Rose was diagnosed with Stage 4 melanoma, a life-threatening form of skin cancer that has spread to his brain, bones and liver.
Although he qualified for emergency coverage from Medicaid, it lasted just six months. Under the Affordable Care Act, he pays $200 a month for premiums — a good deal, he says, given that he had over $250,000 in medical bills last year.
Without that coverage; "I don't know what I'd do," Rose, 34, says. He says insurers denied his earlier applications for coverage, citing his cancer as a pre-existing condition. "I can't fathom the concept of not having any kind of health care," he says.
No one stays healthy forever, he says. Eventually, everyone needs care, either for themselves or their families. "I've paid taxes my whole life," he says. "I don't want anything for free. I don't have a choice."
Radiation oncologist Daniel Fass says cancer patients watching TV in his Rye, N.Y., office waiting room "jumped up and down for joy" as the decision was announced. "They're giddy,'' he says. "The system is on its way to getting fixed."
"This is excellent news. Five million of the 10 million currently uninsured children are now insured and will have access to health care," says Irwin Redlener, professor at Columbia's Mailman School of Public Health and president of the Children's Health Fund. Others are not so optimistic.
"The devil is always in the details," says Suffern, N.Y., neurosurgeon Jeffrey Oppenheim. "How will we be able to afford this? There are no free lunches."
Allen Zagoren, a physician who teaches health care police at Iowa's Drake University, says some physicians fear that the Affordable Care Act will complicate their lives, but notes that many will eventually come to favor it.
"At the end of the day, our job is to provide health care to our patients, and anything the government does to help us do that is good," he says.
Zagoren, who also runs the wound-care center at Iowa Methodist Medical Center, said that more patients soon will have an ability to pay for services, which should help hospitals and physicians. He also said the law includes important incentives for preventive care, which could help save the health care system from rising costs.
Mark Mishek, the president of addiction-treatment-center operator Hazelden, says the court decision is "an essential step forward for millions of people who need help overcoming addiction."
"This historic, lifesaving ruling lifts the burdens and obstacles that had been set before those who wished to find freedom from the disease of addiction," Mishek says. "Expanding access to addiction treatment was a moral and financial imperative. It will save dollars, and, even more important, it will save lives."
White Plains, N.Y., attorney Michael LaMagna, who teaches health care law at Long Island University and has a degree in health care administration, has been following the debate for years.
"What this means is that the 30 million uninsured and underinsured Americans will have access to health care and the 700,000 New Yorkers under the age of 26 will continue to be insured."
The impact on businesses and states that are required to set up insurance exchanges is less clear, he says. "No one knows where the money will come from," he says. Katonah, N.Y., resident Jeanne Waful says she was so nervous before the ruling that she was afraid to turn on her TV. Waful has health insurance through her husband's job at IBM, but says she was thrilled that the Affordable Care Act was upheld. "It benefits all of our society," she says.
"Today's decision is a victory for the health of the America people," says physician Jo Ivey Boufford, president of the New York Academy of Medicine. "Those who are uninsured, underinsured and unable to afford health insurance will finally have access to key preventive services and health care they so desperately need for themselves and their families. The transformation in health policy to emphasize prevention and improve the overall health of the American people, including addressing health disparities, will continue."
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The 2013 Duncan Clark Lecture - The Affordable Care Act on the Verge of Final Success ... and a Nervous Breakdown
Featured Speaker: John E. McDonough, DPH, MPA, Professor of the Practice of Public Health and Director of the Center for Public Health Leadership
Department of Health Policy and Management at the Harvard School of Public Health
December 9, 2013 - On December 2, 2013 NYAM welcomed Dr. John E. McDonough, one of the leading experts on health care reform in the United States, to deliver the 2013 Duncan Clark Lecture at NYAM on “The Affordable Care Act on the Verge of Final Success ... and a Nervous Breakdown.”
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This report identifies opportunities that build on both the Patient Protection and Affordable Health Care Act (ACA) and New York’s ongoing efforts toward improving the health of its 19 million residents.
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