Tomorrow, in a courtroom in Washington, D.C., the fate of one of the most controversial and complex pieces of legislation in U.S. history will be decided by nine judges.
The Supreme Court can strike down all or part of President Barack Obama’s signature health care reform law, cut out just pieces of it, or uphold the law completely. Whatever happens, the implications will be felt by hospitals, doctors, insurers, lawmakers, businesses and millions of average Americans, throughout the country and on the North Shore.
“This is a huge, really big deal,” said Bill Vernon, state director of the Massachusetts Chapter of the National Federation of Independent Businesses, the organization that is the lead plaintiff in the lawsuit challenging the constitutionality of the health care law. “I think small-business owners are really interested in the decision from a philosophical standpoint in terms of the federal government getting involved in their operations, but also on a practical level of what it means to their business.”
Most small-business owners oppose the bill, Vernon said.
But that’s not necessarily the case for individuals.
Carly McClain, a mother of three from Salem and the sister of a woman with bladder cancer, said that between medical screenings for her newborn and doctors’ visits for herself, her husband and her sons, she saved $400 in copays last year because of health care reform. She is anxious about tomorrow’s decision.
“I’m worried about my little sister and what might happen to her health insurance if the law is overturned. I worry about my neighbors with children getting out of college without jobs,” she said, referring to a provision of the law that requires insurers to allow children to be covered under their parents’ plan until the age of 26.
“It’s not right to put money back in the pockets of the insurers while the rest of us are struggling just to make ends meet,” McClain said.
The Massachusetts Medical Society has not come out with an official position, other than the organization’s hope for better access to care for everyone.
“We want everybody to be covered and get health care when they need it. We’re already pretty well down that road in regards to the act the Supreme Court will be deciding on,” Dr. Richard Aghababian, the president of the Massachusetts Medical Society, said in an interview. “We would be disappointed if the same opportunity was not offered to people in other states.”
Aghababian said that the main impact of the federal decision on Massachusetts doctors would be the fate of federal funds and grants sent to the state as part of the Affordable Care Act.
“The No. 1 lifeline we have now is Medicaid support,” he said. “If that were affected, it would really hurt.”
Despite the drama, most experts agree that any major effect of the court’s ruling will be somewhat blunted in Massachusetts by the state’s sweeping 2006 reforms, which provided near-universal coverage and which the federal government used as a model in crafting its plan. Several of the state’s insurers, including the largest, Blue Cross Blue Shield of Massachusetts, have already pledged to keep some of the more popular provisions of the health care overhaul law, including no copays for preventive care and allowing dependents to stay on their parents’ health insurance until age 26.
And no matter what happens tomorrow, there will be parts of health care reform that will live on, said Lori Berry, executive director at Lynn Community Health Center.
The health center received a grant of nearly $7 million in 2010 from a $1.1 billion part of the bill to bolster community health centers. The North Shore Community Health Center in Salem received a $750,000 grant. The Lynn facility used the money to more than double its square footage, double the size of its dental program, and add primary and urgent-care doctors.
Berry hopes, a bit facetiously, that the federal government won’t be asking for the money back.
“I think it would be very hard,” she said with a chuckle. “What are they going to do? Come take our building?”
Polls show the nation is deeply divided on the issue, as are elected officials. The president and congressional Democrats spent almost two years pushing health care reform through Congress. Congressional Republicans have spent the last two trying to repeal it.
Congressman John Tierney, a Salem Democrat, voted for the bill and has been a staunch advocate and supporter in the years that have followed.
“We spent a lot of time and made a lot of compromises. We must have had 75 hearings on this, so we are pretty well steeped in what it does and what it does not,” Tierney said yesterday.
If the Supreme Court overturns the law, Tierney said, Massachusetts seniors would again have a Medicare coverage gap for their prescription drugs, preventive care and screenings would no longer be free for many people, small businesses would lose important federal subsidies, lifetime caps on coverage could be put back into effect, some young adults would be kicked off their parents’ plans, and grant money the state counted on wouldn’t come.
“Caught up in all of this, people lose sight of the reason we passed this bill — the horrible situation of millions of people not covered by insurance and escalating costs that keep escalating,” he said. “This bill has tremendous positive effects in both of those areas.”
Republican Richard Tisei, who is running against Tierney for the 6th District congressional seat, said that, while he supports some measures in the bill, he hopes the Supreme Court overturns it.
“In a perfect world, you would start over and work together to come up with a better plan to provide affordable health care to people,” Tisei said.
As a state legislator, Tisei voted for the Massachusetts health care overhaul on which Obama’s plan is based. But he said that there are key differences between that and the federal law, from the way it’s funded to the way it was enacted, to the situation in Massachusetts and circumstances under which it was conceived.
“The federal bill hurts the economy. There are 21 tax increases in the bill, including the medical device tax,” he said, referring to a 2.3 percent tax on medical devices that will help fund the reforms.
“The bill changes the relationship between doctors and patients and turns the whole health care system upside down,” he said. “It’s going to cost twice as much as Congressman Tierney said it was, and it was passed without consensus or compromise, just rammed through, and created a lot of divisiveness around the country.”
Tisei said he believes states should be left to come up with their own plans.
“The individual mandate might work in some states, and in some states it might not,” he said. “The federal government said, ‘We know what’s best,’ and imposed it on everybody.”