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Officials lawmakers react to health care ruling
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Court ruling still leaves ‘unknowns’ for Kansas small-business operators
Political campaigns once again become battleground for the Affordable Care Act
KHI News Service
WICHITA — Many small-business operators in Kansas and nationwide have been in “wait-and-see” mode for two years pending the Supreme Court’s ruling on the health reform law, which was narrowly upheld today.
But ongoing political opposition to the law and other factors still leave plenty of unknowns, according to a leading Kansas business consultant.
“Businesses have survived new expenses and new mandates in the past. What bothers and concerns business owners the most is the unknown,” said Brad Bechtel of Allen, Gibbs and Houlik, Wichita’s largest business consulting and accounting firm.
Business owners have long shared a common concern, he said.
“When I ask them: ‘What keeps you up at night, what makes you concerned, what are you worried about?’ Every single client said ‘health care,’” he said. “And when I asked specifically, they said ‘The unknown.’”
With today’s ruling, the unknowns are fewer. The court upheld all provisions in the Patient Protection and Affordable Care Act, which has been under fire since before it was signed into law March 23, 2010.
The challenge to the law was brought by 26 states, including Kansas.
Among the remaining unknowns: Will the law survive the coming elections?
Republicans promised to repeal the law and rewrite health reform if the court did not strike it down entirely.
The ongoing political contention may continue to hinder long-term planning for many Kansas business owners, Bechtel said.
“Heaven only knows what’s going to happen now,” he said. “Given the political climate and what we’re hearing from the Republican Party, there’s no doubt going to be a push to modify and change it. They plan on repealing it and rewriting it. So, we’re back to a wait-and-see, to see if they’re successful in doing that. And sadly, Congress has not really proven itself in being able to hit deadlines.
“A lot of businesses are holding a lot of cash, not doing a lot of hiring. Until they better understand what the future is and what those costs are going to be, their hands are in their pockets,” Bechtel said.
Another uncertainty is how the health insurance exchanges will unfold. The law requires that each state have an operational exchange by Jan. 1, 2014. The exchanges are expected to be one-stop, online shopping places where low- and moderate-income people, including many small-business employees, can find affordable health coverage. For those who cannot afford health insurance on their own, the exchanges will provide subsidies or tax credits.
“We don’t know how many individuals will go to the exchange,” Bechtel said, “or how many employers will decide they don’t want an employer-sponsored (health) package. We don’t know that. We have estimates, but the price — the ultimate cost — is still highly unknown.”
When businesses can’t accurately forecast operating costs, “that causes a lot of trepidation,” Bechtel said. “And as a result, I think they tend to hold back. That’s exactly what we’ve been seeing in Kansas and in the U.S. in general.”
Officials at the National Federal of Independent Business, a small-business association closely allied with the Republican Party, said they would continue to push for the law’s repeal.
“Small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses,” NFIB officials said. “We will continue to fight for the repeal of PPACA in the halls of Congress; only with PPACA’s full repeal will Congress have the ability to go back to the drawing board to craft real reform that makes reducing costs a number one priority.”

The ink was barely dry on the United States Supreme Court-issued ruling over the landmark health care reform legislation Thursday morning as many state officials and members of the Kansas congressional delegation blasted the decision, decrying it an act of tyranny and call to elect a new president, while others praised the action.
The  Patient Protection and Affordable Care Act was passed in 2010 by a Democrat-controlled House and Senate and signed into law by President Barack Obama. In its 193-page ruling, the Supreme Court upheld the law – including the requirement that all people who can afford it purchase health insurance or pay a penalty – as constitutional.
In its 5-4 vote which included Chief Justice John Roberts in the majority, the high court said the mandate, the act’s most controversial provision, could remain intact as a tax. Many court observers had expected that provision to be struck down.
Kansas was among the 26 states that challenged the law’s constitutionality, saying the individual mandate was overreaching and that the law’s provisions expanding Medicaid coverage were coercive to states.
“The states’ arguments were not ignored,” said Kansas Attorney General Derek Schmidt. “The Supreme Court today flatly rejected the federal government’s unprecedented power grab under the Commerce Clause.”
It also rejected the federal government’s effort to transform the Medicaid program from a federal-state partnership into a “centralized program run by Washington, from Washington and solely for Washington,” he said. “These legal rulings will benefit the long-term vigor of our federal system.”
 The court ruling, according to early analysis, limited the Medicaid expansion provisions but did not invalidate them.
 Gov. Sam Brownback, like many of his Republican counterparts in other states, insisted his administration would take no steps to implement the law until after the court ruled. Now, “stopping ObamaCare is now in the hands of the American people. It begins with electing a new president this fall,” the governor said in a brief statement issued Tuesday morning
Last year, Brownback returned a $31.5 million federal grant that would have helped the state develop a health insurance exchange. The exchanges, which the law calls for having in place nationwide by Jan. 1, 2014, are a major component of the law

Officials speak out for ruling
Kansas Insurance Commissioner Sandy Praeger, a Republican who helped draft portions of the law on behalf of the National Association of Insurance Commissioners, praised the court’s ruling.
“I’m proud of our country today, that we’ve made that kind of a statement about what our country ought to be doing for everyone,” she said. “I’ve said all along, it’s too bad it’s become so caught up in politics.”
Praeger said leaving the law on the books will mean more Americans have access to affordable medical care.
“Don’t we think it’s right that people in this country have access to health care?” she said. Don’t we think there is a moral responsibility that you not be denied health care because you can’t pay for it?”
“The League of Women Voters of Kansas will continue to educate our community on the ACA and its pivotal impact on lives and work to fully implement the law,” said Ernestine Krehbiel, president of the League of Women Voters of Kansas. “Health care for all must be the goal as we expand coverage to millions of Americans and preserve the Affordable Care Act’s transformational reforms. We expressed great hope when the ACA passed Congress in 2010 after decades of struggle.  Today, we look to a brighter future, a tomorrow that includes health care coverage for all Americans.”
“This decision protects the health of millions of Americans,” said Elisabeth MacNamara, national LWV president. “The Court recognized health care reform for what it is: a legislative response to complex issues threatening the health and well-being of Americans that was best resolved by the elected branch of government – the Congress.  The Court upheld this historic, transformative act of Congress,”

Officials speak out against it
However, “when they look back on the American system of once-limited government, June 28, 2012, will stand as a definitive date in the advance of government tyranny,” freshman Republican Congressman Tim Huelskamp said Thursday. “Today, a slim majority of the Supreme Court turned our Constitution on its head, and ruled that the federal government, in effect, can force upon the American people anything it damn well pleases – as long as it is called a tax. Unlimited federal power, combined with judicial activism, has crafted a new regime that has destroyed our Founders’ vision.”
Not only are individual liberties destroyed, but taxpayers are on the hook for a “non-workable, ineffective, and outrageously expensive health care program,” Huelskamp said. “ObamaCare will drive America into bankruptcy.”
But, Huelskamp said, although the court ruled the law could stand, this does not mean the law should stand. “I will continue to work toward repealing ObamaCare before it is fully implemented, and will continue to support common sense solutions that actually fix – rather than worsen – America’s health care system.”
Huelskamp also doesn’t want to see Medicare funds raided to pay for the new law nor a patient records data base he says will threaten patient privacy. In addition, “we need to kill the provisions that undermine religious liberty. And, we need to eradicate the expensive burdens placed on America’s job creators that will ultimately drive at least 20 million people to lose their workplace-based coverage.”
 “It’s now up to the Congress to repeal and replace this law with step by step, common-sense, cost-cutting solutions that work for Kansans and all Americans, and that’s what I will work to do in the Senate,” said U.S. Sen. Pat Roberts in a prepared statement, calling the ruling a real setback for America.
“I’m deeply disappointed in the Supreme Court’s decision to keep Obamacare in place,” the senior Republican senator said. “This is the wrong decision for our country. After two years, we have seen the problems and pitfalls of this law and they fall squarely on the shoulders of patients and Kansas families. Care will cost more, and access to quality care will be reduced.”