Responses Thursday to the U.S. Supreme Court's decision to uphold most provisions of the health care reform law show the debate about health reform is far from over.
"Right now, it remains as much of a quandary or a question mark as it was before the decision," said Chuck Barnes, executive director of support services at Kennewick General Hospital.
"We really don't know what it's going to mean," Barnes said. "What we hope will happen is more people are able to get insurance."
The court, in a 5-4 decision penned by Chief Justice John Roberts, ruled that the policy known as the "individual mandate" requiring Americans to buy health insurance or pay a penalty was constitutional under Congress's tax power.
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State attorneys general -- including Washington Attorney General Rob McKenna -- who joined in the lawsuit along with the National Federation of Independent Businesses seeking to overturn the 2010 law argued that the Constitution's interstate commerce clause applied and didn't allow Congress to force citizens to engage in commerce by requiring the purchase of health insurance under the policy known as the "individual mandate."
The court agreed, but Roberts found that the option to pay a penalty to the government instead of purchasing health insurance fell under Congress's constitutional tax power.
McKenna told the Herald that even though the court upheld the individual mandate, he thought it was important that it didn't believe it was justified by the commerce clause.
"That is a big relief because the federal government has been making an argument for a much-expanded view of the commerce clause," McKenna said.
The states did win a victory in the part of the majority's decision that told Congress it can't yank existing Medicaid funding from states that choose not to participate in an expanded Medicaid program under the reform law.
McKenna, who is running for governor, said if elected he'll have discussions with the Legislature about whether Washington should participate in the expanded Medicaid program -- which comes with some additional federal funding but also could come with strings that cost the state money.
Three members of the Service International Employees Union 775, which represents some health care workers in the region, delivered a letter to McKenna's Kennewick office Thursday expressing support for the Supreme Court's decision and asking that implementation of the law continue.
"Attorney General McKenna, today we call on you to end your political attacks on health care for Washingtonians," the letter stated. "The Supreme Court has spoken. This decision ends the political debates that have raised uncertainty about the law so that we can move forward on health care and move on to solving other problems -- like jobs and the economy."
McKenna told the Herald he does plan to move forward with implementing pieces of the reform law if elected, such as an insurance exchange that allows people to buy affordable health insurance.
"I like that model because working people can access and own insurance," he said.
But more reforms are needed to truly improve affordability of health care, he added. McKenna favors policies that would allow Washingtonians to buy insurance from out-of-state companies and liability reform curbing the cost to doctors from malpractice lawsuits and driving up the cost of malpractice insurance.
"We need to make health insurance more affordable for everybody," he said. "That means creating a national market for health insurance to promote more competition."
Louis Gonzales, an SEIU member from Walla Walla, told the Herald he'd like to see partisan bickering about the law end.
"Hopefully, this will end the debates and we can get on with providing affordable health care to the citizens of Washington," Gonzales said.
Democratic gubernatorial candidate Jay Inslee also called for an end to debate about the health reform law.
"It is my hope that Republicans do not see today's ruling as an opportunity for further partisan bickering," Inslee said in a statement. "Instead, we need both parties to finally come together and make this law work for the American people."
But many Republicans at the state and federal levels have vowed to keep fighting to repeal the act.
State Sen. Janea Holmquist Newbry, R-Moses Lake, said in a statement that she plans to reintroduce a bill into the Legislature in the 2013 session that would protect Washington employers and workers from taxes, fines and penalties if they refuse to participate in nationalized health care.
"The people of this nation, and the people of this state, have repeatedly said they do not want Obamacare," Holmquist Newbry said. "I have consistently fought attempts to raise taxes on the hard-working families of my district and this state, and today's decision only strengthens my resolve to protect you, your wallet and your rights."
Congressman Doc Hastings, a Pasco Republican representing Central Washington, said in a statement that he'll continue to support full repeal of the law.
"Without full repeal of Obamacare, millions of Americans will continue to lose their current health coverage, seniors will have fewer Medicare choices, unelected unaccountable bureaucrats will be charged with making health care decisions that should be made by individuals, families and doctors, and the government will mandate which health care plans you can use -- all while adding trillions to our ever-growing national debt," Hastings said.
Barnes said that regardless of the political outcome, the health care industry will move ahead with its own reforms out of necessity to combat the double whammy of rising costs and shrinking payments for services.
"I think everyone in health care now realizes we can't go on with the current delivery system without a course correction," Barnes said.
Rand Wortman, CEO of Kadlec Health System in Richland, told the Herald that even with the health reform law, the system needs work.
"What's proposed is not really health care reform -- it's health insurance reform," Wortman said.
Wortman said the nation's health care system must move away from what is termed the "fee for service" model toward a preventive model, in which doctors and hospitals work to keep people healthy instead of treating them when they're sick.
"The current system still pays us for taking care of sick people. The proposed system wants to pay us for preventing illness. But the transition to that is foggy," he said. "Eventually, we will have no choice but to deal with changing the whole system. It's going to be very painful for providers, insurance companies and hospitals. The whole industry will change dramatically."
Barnes said that as the system changes, he anticipates more collaboration between health care providers and other people involved in the system to reduce costs while providing effective care.
"Reform will go on regardless of what happens with the political football," Barnes said.