Board of Supervisors Chairman John Moorlach, an opponent of the national health plan upheld by the U.S. Supreme Court Thursday, warned it could lead to poorer health care overall for future generations.
And, Moorlach predicted, Pres. Barack Obama, who strongly promoted the plan, may have won the battle but lost the war.
“I think Obama won the ruling today, but he loses the White House in November,” said Moorlach, a Republican, referring to polls that show most voters opposed to the new mandatory health insurance law, although they favor sections of it, like requiring insurance companies to cover patients with pre-existing conditions.
Moorlach said the county will implement whatever laws and regulations are necessary but added he was concerned the new law will discourage men and women from becoming medical professionals because they won’t be paid at private industry rates for many patients.
He said he worried that a long-term shortage of doctors and others could lead to “rationing” of medical care, with long delays for treatment of serious conditions.
“It [the new law] just creates a whole different dynamic,” he said. “You can see what goes on over time by looking at other countries” with mandatory health coverage.
All five county supervisors are Republicans who oppose what they call “Obamacare.”
A majority of the board has voted against accepting federal grants to implement programs they believed might support the new law, beginning with an effort to fight obesity in 2011.
Supervisor Shawn Nelson, a lawyer, said he understood the legal reasoning behind upholding the law as a tax but said it will hit hardest at the “lower middle class” and adults in their late 20s who will have to pay 2 percent of their salaries or a $695 fine, whichever is more, if they fail to get health insurance.
Those who run into financial trouble and can’t pay their health insurance payments will be penalized, he said.
Supervisor Janet Nguyen, the supervisor who led a restructuring of CalOptima, the county’s health plan for about 400,000 poor women and children, disabled adults and the elderly, said she was “definitely surprised by the Supreme Court’s unfortunate ruling today.”
Nguyen predicted as many as 250,000 more adults could be eligible for CalOptima coverage as a result of the law. CalOptima provides Medi-Cal coverage in Orange County. In earlier estimates, CalOptima estimated that 100,000 new patients — single men and women who currently aren’t eligible — would enroll when the new federal law takes effect in 2014.
“If the state and federal government don’t provide the necessary funding, it will greatly hurt the county, CalOptima and more importantly the taxpayers of Orange County,” Nguyen asserted in a prepared statement.
About 24 percent of Orange County adults lack health insurance, according to a report this year by The Commonwealth Fund health foundation that analyzed health care around the nation.
Under current law, doctors, hospitals and other health providers who treat uninsured patients might wind up absorbing the costs. Counties also pay for some emergency care.
At the same time, uninsured patients might avoid consulting a doctor because they can’t pay, then wind up in an emergency room when their conditions becomes more serious.
CalOptima CEO Michael Engelhard declared in a written statement that “our focus is to remain steadfast in our longstanding commitment to provide access to quality health care services delivered in a cost-effective and compassionate manner."
The county Health Care Agency still is studying the requirements of the federal law and had no immediate assessment of its impact. The Social Services Agency is responsible for determining the eligibility of applicants for government health assistance but isn’t involved in administering the programs. The agency will face limited impact, according to spokeswoman Terry Lynn Fisher.
But Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers, an organization of 27 community clinics, said, “Many of the provisions are already in place in our communities, and we as a county have been preparing for the expansion of Medicaid for two years."
She said the clinics have been working with CalOptima and the Health Care Agency “to ensure system enhancements are in place for a seamless transition of beneficiaries and capacity enhancement for expected increase in enrollees.”
She said she expects the clinics and the patients they serve to “fare extremely well” because of additional federal resources coming to the county.
The Orange County Medical Association, like the statewide organization, had supported the federal legislation but had concerns as well.
“I think what we are happy with in general is universal coverage,” said Robert McCann, executive director of the Orange County organization.
He said doctors are worried about a pending 32 percent cut in their payments scheduled for next year, unless Congress makes changes.
In addition, he said the new federal law includes an “independent payment advisory board” whose authority doctors believe is too vaguely defined.
McCann said doctors are worried the board could start deciding what treatments they could or couldn’t give patients. “We’re not really sure what that board could do,” he said.
Deborah Proctor, president and CEO of St. Joseph Health, which operates three hospitals in Orange County, declared in a prepared statement that the nonprofit still is studying all of the implications of the Supreme Court decision but overall was “pleased that the Affordable Care Act has been found constitutional and will remain in effect. Our organization supports health reform that expands access and coverage to everyone.”
Added Proctor, “We understand how families and employers are struggling, and we are extremely concerned about the accessibility and affordability of health care services. Health care reform will enable people to get the care they need.”
Dr. Richard Afable, president and CEO of Hoag Hospital in Newport Beach, declared in a written statement that "given today's Supreme Court decision, providers of healthcare services will be watching the political climate closely over the next 6-12 months. However, today's ruling provides the clarity that many or most of the Affordable Care Act provisions will be enacted as written. This will be a major change in the delivery and receiving of healthcare services for years to come.
“The process of change that has begun for doctors and hospitals will now proceed at full speed,” he stated. “Let's hope that the ultimate recipient of benefit and value will be our patients and our communities."