Supreme court ruling: State option on Medicaid surprises area medical experts

Corey Perrine/Staff
Volunteer Emmy Brown helps retrieve, organize patient filesThursday, June 28, 2012 at Neighborhood Health Clinic in Naples, Fla.

Photo by COREY PERRINE, Naples Daily News // Buy this photo

Corey Perrine/Staff Volunteer Emmy Brown helps retrieve, organize patient filesThursday, June 28, 2012 at Neighborhood Health Clinic in Naples, Fla.

Video from NBC-2

— One wait is over and a new one begins to see what unfolds.

Southwest Florida health-care leaders, from hospitals to clinic directors, were bracing for the U.S. Supreme Court to rule on the mandate that individuals must buy insurance.

Instead, they were surprised the court ruled that states don't have to expand Medicaid for the disabled and poor.

"It leaves the decision to states to decide what to do but the federal government will pick up the tab (for Medicaid expansion). Florida could choose not to do that," said Dr. Larry Antonucci, chief operating officer for the Lee Memorial Healthcare System in Lee County. "What happens to the 5 million Florida residents who have been counting on that? Nobody expected that. All you heard was (talk) of the individual mandate."

Dr. Jerry Williamson, chief medical officer of the Healthcare Network of Southwest Florida, said he sees problems allowing states to pass on expanding Medicaid.

"I think many of the states will in fact, opt out," he said. "It could potentially leave 15 million people with no affordable coverage."

Thursday's decision does remove a lot of uncertainty for the hospital industry but the final outcome is far from clear because of the November elections, said Alan Levine, president of the Florida Group for Naples-based Health Management Associates. HMA operates 22 hospitals in the state, including two Physicians Regional Healthcare System hospitals in Collier County.

"We stand ready to work with Congress with whatever happens after the elections," said Levine, who served as secretary for the Florida Agency on Healthcare Administration from 2004 to 2006 before joining HMA.

In the meantime, HMA hospitals will continue to focus on cost efficiency and improving patient care, he said.

"If costs are manageable and you are efficient and have high quality, you are going to be part of whatever system emerges," he said.

The court ruling has no immediate effect on the hospital industry, Lee Memorial's Antonucci said. Hospitals will continue to focus on bringing costs down, reducing avoidable readmissions, and improving patient care because Medicare requires it.

"Regardless of what reform looks like, in reality we know there are fewer dollars," he said. "We have been moving along those lines. We can't get too agitated over the politics."

Dr. Allen Weiss, president of the NCH Healthcare System in Collier County, agreed Thursday's decision has no immediate effect on hospitals.

"We continue to work on quality and continue to work on being smarter with limited resources," he said, adding that a third focus is technology.

The health-care reform law also directs hospitals to collaborate with physicians and that will evolve over the coming years, Weiss said. That will apply to both for-profit and nonprofit hospitals.

A Fort Myers nurse, Laura Brennaman, camped Wednesday night on the sidewalk outside of the Supreme Court building to get a ticket Thursday to hear Justice Roberts read the ruling.

"I was second in line to get a ticket," said Brennaman, 53, who teaches part time at Nova University.

Brennaman was jubilant after the ruling because it is the first major action in 50 years to start providing quality care to everyone, although she would prefer a single-payer system. She was disappointed by the court's decision to allow states to forgo Medicaid expansion.

"What will Florida do about that?" she said, adding that it was the shocking part of the decision and nobody had bets on that. "It will cost Florida a lot more not to take the expansion."

At the Neighborhood Health Clinic on Thursday, Dr. George Ferguson said the mood was upbeat, regardless of the Supreme Court decision. The clinic, which depends solely on donations and patient fees, serves uninsured working-poor residents of Collier.

"I think it's not going to change what we do at the clinic," Ferguson said.

Even though the individual mandate has been upheld, people are waiting to see what happens in the November elections, he said. And he's not sure if the clinic's patient volume will go down if the individual mandate goes forward. It's likely many people will remain uninsured.

One longtime clinic patient, Kwistaunda Sanders, said she is fearful of being forced to buy insurance that she can't afford and being penalized if she doesn't.

"That makes me really nervous," she said, adding that she is self-employed with her own commercial and residential cleaning business in Naples. Her income fluctuates between the busier tourism season and the slow summer months.

"I will either do all the work myself or find other work to supplement my income," she said.

Sanders, who has diabetes, is skeptical that insurance companies will be prohibited from discriminating against her with higher premiums

"I'm not buying that," she said of insurers. "You can't tell me they are not already in their board rooms working on their schemes to avoid it. Insurance companies are not altruistic."

Some patients who are 50 and older who get their medical care at Friendship Health Clinic of Collier County say they have been following the politics of the health-care law, said Betty Gamel, the clinic's director.

"Others are just waiting to see what happens," Gamel said. "I have very mixed feelings. I think people should have insurance. I'm not sure if it's the government's place to mandate. If you don't have a job or money, it's hard. I'm the first to say our health-care system is broken. I'm not sure this is the way to fix it."

© 2012 marconews.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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