Obamacare Gets a Thumbs Up: What Does It Mean?

The Associated Press’s Mark Sherman has a thorough story about the Supreme Court’s upholding the Affordable Care Act.  

Health care experts at the University of Georgia reacted to today’s ruling and speculated about what it may mean for Georgia.

Phedra Corso, Department Head
, Health Policy and Management, College of Public Health.

I think there are big implications for the state of Georgia and other states. They have to pull together the state-based health exchanges, which are required under the ACA. The states have to have a marketplace where insurance companies can compete for the business of individuals or small businesses. The state will create their own exchanges. The State of Georgia has been on hold, waiting for the Act to be declared Constitutional. Now that it has been, they need to move forward to have it ready by 2014. Many states now are going to be scrambling.

Medicaid expansion isn’t mandatory. They can choose to expand or not. If not, they won’t have the current Medicaid dollars they receive from the federal government taken away. I think Georgia will choose not to do the expansion, even though the federal government will cover the expansion fully for a couple of years. And that means there are going to be a lot of poor people without access to health care. There’s no penalty for not expanding the Medicaid program.

There are 2 million Georgians with no health insurance. Many of them could potentially be covered if Georgia expands its Medicaid program. Whether it’s a win depends if you are the state government or a citizen in the state. People who will benefit will be those with pre-existing conditions. There will be no out of pocket costs for preventive services, there will be coverage for young adults on their parents’ health insurance policies. Some parts will still need wrangling.

 W. David Bradford, Busbee Chair in Public Policy, 
Department of Public Administration and Policy, School of Public and International Affairs.

It means a number of things for Georgia. Of the several million uninsured people, by 2014, most of them will have an obligation to purchase health insurance. Poor folks will get subsidies to do so, small businesses will get subsidies to offer them. There will be a reduction in the number of uninsured folks.

We have to figure out how to get them in the program.

Georgia is going to have no choice but to expand the Medicaid program. The federal government will pay that cost, 100 percent for several years. The government will contribute 90 percent of the cost of the program, the most Georgia will pay in the future is 10 percent, and this 10 percent will be in the future. The marginal cost will be paid through the federal government. The taxes will come from us. The Medicaid expansion isn’t going to be a substantial issue for some time.

I believe taxes are going to rise. You can’t budget it by cutting spending. Yes, they will rise but they were going to rise anyway. How much they will go up? No definitive answer to this. There’s no way that increasing the number of people insured and their access to health care was going to be free. It’s going to cost someone something.

Hospitals have seen pressure on their bottom line. It’s not in any of our interests to have a weak hospital sector. It’s better to get everyone under some mechanism of payment. That’s what they are hoping for.

It will be an interesting narrative if Deal or another governor says he won’t let the poor people in the state be insured. If he says no, he’s saying, ‘I don’t want to insure poor people even though it won’t cost me a penny.’

Toni Miles, Department Head, 
Institute of Gerontology, College of Public Health

The citizens of Georgia won today. What we needed was clarification on those two issues, the mandate and Medicaid, and we got clarification. I am really focused on the expansion of Medicaid, which has implications for young adults and for seniors. Expansion gives the states flexibility to do what they need, the way the court ruled on it.

Basically, it gives the states what they need to protect the future, our kids, and to honor the past, our kids.

Legislation puts Medicaid physician payments on par with Medicare payments, which it isn’t right now. The states will still have to figure out how to work that balance. The expansion pumps federal dollars into the state Medicaid budget for people who have coverage right now.

I’m just happy that we got the law clarified and we move forward. Hospital administrators and everyone whose job it was to implement the law was in a holding pattern because they didn’t know what to do.

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