Health care court ruling prompts more debate

Tony Gagliardi
Steve Erkenbrack
Dr. Michael Pramenki








Phil Castle, The Business Times

Depending on who you talk to, the Supreme Court ruling upholding federal health care legislation constitutes a disappointing decision that will impose one of the largest tax increases in U.S. history, a move that stabilizes the framework under which the health care system will operate or a step toward needed changes.

There’s consensus, however, that far more work is needed to address one of the most pressing issues of all related to health care, and that’s rising costs.

“This is not easy to do,” said Steve ErkenBrack, president and chief executive officer of Rocky Mountain Health Plans in Grand Junction. “If it were easy to do, we wold have done it already.”

The Supreme Court upheld most of the provisions of the Patient Protection and Affordable Care Act, including a provision dubbed the individual mandate that requires the purchase of health insurance or the payment of a penalty. Writing for a 5-4 majority, Chief Justice John Roberts said the individual mandate constitutes an unconstitutional requirement, but Congress retains authority to levy and collect taxes on people who don’t purchase insurance.

Tony Gagliardi, state director of the National Federation of Independent Business in Colorado, decried the ruling as a “disappointing” decision. “The court affirmed this will be the biggest tax increase in our nation’s history,” he said.

If fully implemented over the coming years, health care legislation will impose a variety of new taxes and regulations that will only serve to undermine economic recovery, Gagliardi said. By one estimate from the NFIB, health care legislation will impose more than 20 new taxes with a price tag of $800 billion. Most of the regulations implementing the law haven’t yet been written.

The NFIB, a small business advocacy group based in Washington, D.C., was the lead plaintiff in the case before the Supreme Court, joining 26 states in arguing against the constitutionality of the individual mandate.

Given the court ruling, Gagliardi said the NFIB will continue to work to repeal the health care law legislatively or, barring that, influence regulations as they are drafted.

While the health care law potentially could be repealed, ErkenBrack said he expects the law to go forward, providing a framework under which the health care system will operate.

Even as the law and Supreme Court ruling have provoked a bipartisan debate, both political parties are right about some things, ErkenBrack said. Democrats are right to argue something must be done to curb increasing health care costs. Republicans are right to assert that health care reforms shouldn’t be pushed through Congress on a strictly partisan vote.

The question now, he said, is whether the parties can work together to implement the law and address problems.

As for the individual mandate requiring health insurance coverage, ErkenBrack said it’s essential if another provision of the law requiring guaranteed insurance coverage also is implemented.

A blue ribbon panel created by the Colorado Legislature to study health care of which ErkenBrack was a member recommended mandated coverage. But incentives could offer a better way to encourage coverage than a penalty, he said.

Meanwhile, Colorado remains better positioned than all but a handful of states to implement health care legislation, ErkenBrack said. State legislation enacted last year establishes a health benefits exchange that will create a marketplace for insurance. ErkenBrack also serves on a nine-member board of directors developing the exchange.

Dr. Michael Pramenko, a family practitioner who also serves as executive director of Primary Care Partners in Grand Junction, said he was relieved by the Supreme Court ruling because the health care law offers a step toward needed changes in the health care system.

Like ErkenBrack, Pramenko said the individual mandate is needed if insurers also are required to cover everyone, including those with pre-existing conditions. Otherwise, a government-run health care system offers the only other alternative.

Pramenko also noted the blue ribbon panel on health care, Club 20 and Colorado Medical Society all have supported the individual mandate. And before the latest political debate about health care, the concept of an individual mandate was proposed by conservatives, he added.

Moreover, the health care legislation includes provisions promoting other changes Pramenko said are needed, including a shift away from paying health care providers a fee for services that encourages quantity over quality.

Nonetheless, Gagliardi, ErkenBrack and Pramenko all agreed additional changes are needed to bring down escalating health care costs.

Gagliardi said the NFIB long has advocated for defined contribution plans, insurance portability, access across state lines to benefit plans and malpractice reform.

ErkenBrack said eliminating the cost shift that occurs when people without insurance use emergency rooms and government payments fall short of covering services provided under government programs would lower health care costs by 30 percent.

Pramenko agreed malpractice reforms are needed, as are sufficient payments under government programs. But so is a realization that not all medical tests or procedures are needed or should be paid for by insurance or government benefits.