At the headquarters of the northern Red River Valley's largest health care system Thursday morning, executives watched the Supreme Court's decision on a national health care law but their focus was elsewhere.
"Like the whole rest of the country, we didn't know what was going to happen," said Dave Molmen, chief executive officer for Altru Health System.
But Molmen said the court's decision to uphold the Affordable Care Act, like much of the act itself, was more of a matter of how people were insured rather than how providers treat patients.
While the court's decision maintained most of the act's provisions to extend coverage to the uninsured and require individuals to carry insurance, Molmen said it had little effect on controlling costs of care, reduce chronic conditions driving medical costs or quality of care.
"That's really where we've been focusing most of our efforts," Molmen said.
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Raising demand
One way the law has shaped Altru's planning so far is through the expectation of expanded coverage to more of the population. Chief Planning Executive Dennis Reisnour said the system has been investing in recruiting physicians and expanding and improving its facilities in anticipation of increasing volume.
"People have insurance so they'll have a better ability to see a doctor," he said. "Capacity is going to be a big one. We're already increasing our capacity."
Extending the use of primary care, with its emphasis on health maintenance, holds the prospect of reducing the need for more expensive acute care and could also reduce the amount of treatment Altru provides to people who cannot pay for it, Molmen and Reisnour said.
The health care law does not have a strong effect on payments from Medicare and Medicaid to providers.
A bigger factor in that question will be Congress' ability to address deficits before automatic federal spending cuts are imposed on the programs, Molmen said. "Our anticipation is that payments are going to continue to be ratcheted down."
One area the ruling made more certain is the continuation of the Frontier Amendment that increased Medicare payments to providers in North Dakota, though the provision has been threatened with elimination in debates over the federal budget.
The executives declined to share their views on any parts of the act they supported or opposed, saying the system did not have a stance on the act itself.
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"We probably have 4,000 views on that in our organization alone," Reisnour said.
Reaction elsewhere
The sense that the survival of the law did not alter other factors affecting health care was shared among other local organizations.
Corey Mock, executive director of the Third Street Clinic in Grand Forks, said Thursday's ruling had little immediate impact on his operation, which provides primary care and other assistance for needy patients who are ineligible for other government assistance.
If the Supreme Court had struck down the act, demand for the clinic's services would have remained strong, Mock said.
According to him, the ruling leaves some uncertainty for the clinic concerning how Medicaid, which provides medical care for many poor, will extend its coverage as was required by the law. Since Third Street requires that its client be ineligible for Medicaid, greater coverage would shift many of the people it serves to other services.
Thursday's decision removed some of the federal government's power to compel states into extending Medicaid coverage.
Regardless of the court's decision, health care costs will still be increasing beyond many people's ability to afford them, according to Mock.
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"There will continue to be people who fall through the health care cracks," he said.
The leader of an effort to establish a community health center to provide primary care on a sliding scale said the court's decision preserved the act's funding increases for such centers, though receiving that money remained complex.
"It would have made the process much more competitive," said Mara Jiran of the Alliance for Healthcare Access, the group trying to open the clinic.
Thursday's decision removed some of the uncertainty over whether support for the centers would continue.
"It's definitely one piece of the puzzle that's no longer a question," Jiran said.
Reach Bjorke at (701) 780-1117; (800) 477-6572, ext. 117; or send e-mail to cbjorke@gfherald.com .
