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By Emily Ford
eford@salisburypost.com
SALISBURY — For Dr. William Pilkington, the public health director in Cabarrus County, the Supreme Court’s decision to uphold the Affordable Care Act means less human suffering and equal access to health insurance.
For Frank Goodnight, a small business owner in Salisbury, the ruling is a step toward socialism.
Pilkington and Goodnight represent the mixed local reaction Thursday to the landmark ruling. The Supreme Court surprised both men by upholding the 2010 law that requires everyone to have health insurance, prevents insurance companies from denying coverage based upon pre-existing conditions, allows students up to age 26 to remain on their parents’ insurance and requires companies with more than 50 employees to offer health insurance.
“Anything we can do to improve the access and availability of health care to our population will be a huge impact in terms of diseases we prevent and dollars we save,” said Pilkington, director of the Cabarrus Health Alliance.
Insured people are healthier and cost the health-care system less because they are more likely have a doctor, who can find and treat ailments before they result in catastrophic illness, Pilkington said.
In North Carolina, 1.57 million residents are uninsured, or about 17 percent.
The Affordable Care Act forces the American people to buy a product and does nothing to control the skyrocketing cost of health care, Goodnight said.
“This ruling has stunned us all,” said Goodnight, who owns Diversified Graphics and serves on the N.C. Leadership Council for the National Federation of Independent Business. “To me, it’s just the start down the road to socialism.”
Goodnight already offers health insurance to his eight employees but said half have dropped the coverage because rates went up 20 percent last year and 25 percent this year. The law does not include two measures Goodnight said would cut health care costs — tort reform and allowing insurance companies to compete across state lines.
Dyke Messinger, president of Power Curbers in Salisbury, also said he’s concerned with out-of-control health care costs. While Messinger said he supports the provision to expand health care coverage, he said President Obama erred by not addressing cost.
“In the rush to make something happen, that side of the equation was just really not touched,” Messinger said. “Now, the work we have in front of us is to build a healthcare program we can all afford.”
Dari Caldwell, president of Rowan Regional Medical Center, said the hospital has been preparing for the Affordable Care Act for two years by cutting costs, becoming more efficient and establishing new quality measures to decrease infection and increase safety.
“I am tremendously relieved just to have a decision,” Caldwell said. “It has been challenging to try to figure out how to prepare for the future.”
The Affordable Care Act requires hospitals to be more affordable, efficient and accountable for the care they provide. Because of early legwork, Caldwell said, Rowan Regional is well-positioned to perform under the new law and would have continued many of the changes regardless of the Supreme Court’s ruling. “Even if it had overturned, we would be on the same path,” Caldwell said. “We have been focusing on quality and safety before it was in vogue to do so.”
More people will seek medical attention if they have health insurance, Caldwell said, and that means Rowan County needs more doctors, particularly in underserved rural areas.
While all 27 primary care physicians in Rowan were still taking new patients the last time Caldwell checked, she said the hospital hopes to recruit 25 more doctors in primary care and specialities during the next two years.
That’s in addition to the 39 physicians recruited in 2011, she said.
Rowan Regional has partnered with Cabarrus Health Alliance to open a new clinic as part of the South Rowan Medical Mall in China Grove, expected to treat 5,000 children and adults a year. A $379,167 federal grant will fund the project.
For two years, the hospital has made financial projections assuming every patient is insured and the hospital is reimbursed at the Medicare rate. Using this scenario, Caldwell then determines how much to cut in expenses “not even to turn a profit, but just to break even,” she said.
The hospital will operate in a similar environment under the Affordable Care Act, and Caldwell said Rowan Regional leads Novant, the hospital’s parent company, in the exercise.
The new law will mean more people receive more preventative health screenings, which will enable doctors to catch disease and chronic conditions earlier, Caldwell said. With a new mobile mammography unit, Rowan Regional aims to screen 100 percent of eligible women for breast cancer, up from about 35 percent now.
Caldwell last year began a program to assign a primary care physician to every patient discharged from the hospital who doesn’t have a doctor. The 27 primary care doctors set up a rotation to accept these patients, about one per day, who are often uninsured.
But that’s only the tip of the iceberg, Caldwell said.
“We’ve got a lot of people who are not going to the doctor all because they don’t have money or insurance, or they have a really high deductible,” she said.
The new law, which is phased in over a decade, in 2014 limits the annual deductible insurers can charge customers.
North Carolinians are evenly split on whether the federal government should ensure that everyone has health care coverage, according to an Elon University poll.
But a majority of state residents don’t like the Affordable Care Act — 46 percent to 38 percent — and don’t think it will result in better health care in the long term.
Leonard Wood, director of the Rowan County Health Department, didn’t give a rousing endorsement of the Affordable Care Act but said it has some benefits.
“It’s a good first step in trying to spread the cost of health care across everyone who uses health care, and that includes people who do not buy health insurance currently,” Wood said.
Bob Wright, president of the Rowan County Chamber of Commerce, said the chamber opposes any effort to require employers to provide specific benefits.
Greg Edds, chairman of the chamber’s board of directors, said the Supreme Court’s ruling gave the government a new set of powers and predicted “mountains of regulations” imposed by “bureaucrats and busybodies.”
“Make no mistake, every American at every income level will see their taxes escalate and the cost of the goods and services they use increase,” said Edds, chairman of the Rowan Republican Party and owner of State Farm Insurance. “No one will be exempt from the taxes necessary to support the president’s ill-advised health care takeover.”
Under the Affordable Care Act, states are supposed to create one-stop shops to help people and small businesses find affordable health insurance. But N.C. Senate leader Phil Berger said Thursday senators do not intend to take up legislation this year to create the health benefit exchange.
State plans for the exchanges are due to the federal government by this fall. The federal government will create exchanges for states that don’t have them by 2014.
Only 14 states and Washington D.C. have adopted a plan for carrying out the law creating exchanges that steer middle-class households to private plans.
Dr. Boyd Watts said despite Thursday’s ruling, the issue of health-care reform is “still wide open” because the Supreme Court limited the federal government’s ability to force states to expand Medicaid. “This is not really going to solve the problem about getting people insured for a reasonable amount of money,” said Watts, a physician with Pinnacle Orthopedic Associates.
While the provisions that were upheld will not affect his practice, Watts said, they “will affect everybody’s pocketbook, because it seems like a tax increase to me.”
The new law does nothing to deal with abuse of the health-care system by people who can use it for free or at low cost, said Rip Kersey, a management consultant and former engineer who ran for Salisbury City Council last year.
Health care costs are going up due to the “day-to-day continuing overuse of the medical system,” said Kersey, who is married to a physician. “Nothing in this law will change that. This will exacerbate it, if anything.”
Pilkington disagreed and said people need more access to health care, not less.
Despite the outcry from physicians and business owners, Pilkington said the Affordable Care Act is a “minor tweak in the private insurance system to make it more fair,” not a step toward socialism.
Thursday’s ruling showed the Supreme Court can rise above politics, Pilkington said. Conservative Chief Justice John Roberts sided with liberal justices to form a 5-4 majority to uphold the Affordable Care Act.
“We have to go down this path because the cost would be too great not to, and that cost is human suffering and the unavailability of health services,” Pilkington said. “We had to take some step.”
The Associated Press contributed to this story.
Contact reporter Emily Ford at 704-797-4264.

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