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Mixed feelings shared on Obamacare decision

Local health care providers said they have mixed feelings on the nation's health care reform being ruled constitutional, but generally agreed that the decision means it is time to move forward.

"Now we know this is a starting point, so let's work from that, " Dave Henry, CEO and president of Northern Montana Healthcare, said this morning. "I think we'll be sorting this out for quite a while. "

A sharply divided U. S. Supreme Court this morning ruled 5-4 that almost all provisions of the Affordable Care Act — commonly called Obamacare, including by President Obama — are constitutional.

Jared Payne, CEO of Sweet Medical Center in Chinook and Harlem, said he has mixed feelings on the decision.

While parts of the health care reform program are helpful, like moving the U. S. medical industry forward by improving its use of technology, Payne said, he doubts the country can sustain the reform act programs.

"I find it hard to believe that there are a lot of cost-savings in the program that's presented by the (Affordable Care Act) and it would be difficult for our country to sustain in the long run, " he said.

Cindy Smith, executive director of Bullhook Community Health Center, said the act now is confirmed as the law of the land and health care providers need to work with it as best they can.

"There are a lot of very positive things that it can mean for the people of Montana, " Smith said. "There are a lot of pieces that still have to be put together. "

Ron Gleason, CEO of Liberty Medical Center in Chester, said he was surprised — he expected the mandate requiring people to buy health insurance to be struck down and the required state expansion of Medicaid to stay. The opposite occurred.

"We've got to move forward with it, " he said. "It is what it is, regardless of what any of us that are not on the Supreme Court thinks. "

Jared Bold, administrator of the Big Sandy Medical Center, said he wanted to review the lengthy Supreme Court decision and look at its implications before making any specific comments on it or on the Affordable Care Act.

He did say that one intent of the act — increasing insurance coverage — would help with costs.

"The more people that have health insurance, hopefully that will spread the cost more evenly across the spectrum versus the way it is now, where those that have health insurance usually pay higher (cost for) care because of the uninsured, " Bold said. "The uninsured has been a big problem. "

Henry said that mandating coverage is the only way the program could work. Requiring companies to provide coverage for people with pre-existing conditions and preventing limits on maximum benefits, for example, could not be paid for otherwise.

"You have to have the pool expanded so you get the younger folks that are healthy in insurance. If you don't have the mandate, none of us could afford the insurance …, " Henry said. "It means you have to have a large healthy pool to offset the rest of us who may need that insurance. "

But, he said, many questions need to be answered — for example, will states have to expand their Medicaid coverage or can they avoid that if desired; will states have to set up insurance exchanges.

"There is a lot of wiggle room in this right now, and people are trying to sort it out, " he said. "Unfortunately, we do need some sort of overhaul in the health care programs, because things are expensive, and it may be that Supreme Court ruling is so conflicted it may force the legislators to go back to the table and come up with a more understandable (act) that we can all deal with. "

Gleason said he was concerned, as Henry was, about how the ruling on Medicaid would play out.

Most of the people in health care agreed that more work needs to be done to improve the bill that passed in 2009.

"I think it's a good start for us to start getting to the table to talk about how crazy health care expenditures are and how out of hand, " Smith said. "Hopefully, this will force some of that, and we just go on to do good things with it and look at the things that need to be revised. "

"I think there are some things in the act are probably very good for health care in our country. I think there are some things in the act that you just can't interpret and make sense out of, so I think tweaking needs to be done, and the question is how big is it, a capital tweak or a small letter tweak, " Henry said. "But there is no question that Obamacare, as we call it, right now is unmanageable, and so can we get it to the point where it is workable and understandable and the states and the individuals and the employers all know what the rules are and what it's going to cost. "

A look at the federal health care law in Montana

The Associated Press

Number of uninsured: 176,000 state residents are uninsured, or about 18.1 percent.

Where the state stands: Republican lawmakers in Montana who controlled the Legislature rejected any efforts to establish a health insurance exchange.

What happens now: Montana insurance commissioner Monica Lindeen says the state may still make suggestions to the Department of Health and Human Services as it establishes Montana's exchange. Lindeen expects private insurers will begin submitting to her office next summer the plans they propose to sell on the exchange, at which point the cost to consumers after tax credits will become known.


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