The U.S. Supreme Court's decision to uphold the Affordable Care Act invoked a range of emotions from local health care officials Thursday.
Surprise at the ruling. Excitement for the uninsured who will have access to health coverage. Enthusiasm for health care reform. And a sense of urgency to make sure the system is ready for an influx of patients in 2014.
But while health officials praised the benefits of the decision, they also recognized the challenges that remain for the U.S. health care system.
"This is a high water mark for America, much like the Medicare and Medicaid decisions back in the '60s," said Dr. George Brown, president and chief executive officer for Legacy Health. "But we have real and persistent challenges ahead of us to get health care to as many Americans as possible. This is just one more chapter in a long essay on American health care."
In Clark County, the court decision could benefit up to 79 percent of uninsured residents -- about
51,900 people, according to a report from the Washington State Office of the Insurance Commissioner.
Insurance Commissioner Mike Kreidler released the report detailing the county-by-county impact of the Affordable Care Act last month.
The report projects Clark County's total population to be 438,200 by Dec. 31, 2013. About 65,600 people younger than 65 -- or about 15 percent of the total population -- are expected to be uninsured, according to the report.
While the Supreme Court upheld the Affordable Care Act, it essentially gave states an option of whether to expand their Medicaid programs to include more uninsured, low-income residents.
If Washington state elects to expand its Medicaid program, about 20,000 uninsured people would qualify for Medicaid coverage. And, under the act, about 31,900 uninsured people would qualify for subsidies to help pay for insurance, according to the report.
Giving the most vulnerable population access to health coverage is important in order to ensure people are not only receiving primary and preventative health care but also specialty care, said Mark Carlson, clinic manager for the Sea Mar Community Health Centers in Clark County.
Of the 35,000 patient visits last year to the two Sea Mar centers in Clark County, about half were uninsured. The clinic has family practitioners who can provide general care to those people, but referring uninsured patients to specialists is difficult, Carlson said. Many specialists don't accept uninsured patients or those who can't pay, he said.
Getting the uninsured health coverage will also mean undiagnosed conditions can be caught, hopefully early, and treated before the situation becomes critical, Carlson said.
"It's just so exciting to see what can happen to the most vulnerable," he said.
Moving forward, the focus for providers and insurers remains unchanged: transform the health care delivery system so that it provides higher quality health care that's affordable and improves the patient experience.
"That's where we need to move," Brown said. "Hopefully, passage of the ACA will help us more quickly realize those goals."
Dwindling Medicaid financing, however, poses a challenge, according to a written statement from Joe Ness, senior vice president of operations for PeaceHealth Southwest Medical Center.
"PeaceHealth Southwest supports reform based on our long-standing conviction that all Americans should have access to basic health services and health insurance," Ness wrote. "Now the real work begins to improve access in the face of chronic Medicaid underfunding and the federal deficit."
While the law does a good job of providing access to insurance and coverage, it doesn't address the unsustainable rise of health care costs, said Scott Burton, spokesman for Regence BlueCross BlueShield of Oregon. That's an issue that must be addressed, he said.
"Access is one thing," he said, "but if we can't address the cost, it makes access very, very tough to implement."