The U.S. Supreme Court upheld most of the federal health care law in a ruling this morning. Among Missouri officials, and on the streets of downtown Columbia this afternoon, reaction was mixed.
Skip Ducharme, who owns a downtown coffee shop, said he's nervous about the effects of the ruling, if he has to buy insurance for his baristas. "I'm a small business owner with 25 employees. I can't afford that. There's a real chance I'll be out of business in a couple years, along with 25 other people," he said. "These are tough times economically."
Kelsey Cunningham, who was downtown for the lunch hour, was happy about the ruling. "Everyone in America should have affordable health care," she said. "Everyone should be covered, and if I have to pay a little more out of pocket so that someone else can be covered, I'm happy to do that."
The court ruled 5 to 4 to uphold most of the Affordable Care Act, with Chief Justice John Roberts — a Republican appointee – siding with the court's four liberal justices.
But the ruling didn't placate conservative critics:
"Lots of things are constitutional that the country shouldn't do," said Roy Blunt, Missouri's Republican senator. Blunt immediately responded to the court ruling in a press conference this morning. "I think voters are going to look for ways to express that we should not go forward with this, and that will have a big impact on what happens in November."
Missouri's two highest-ranking Democrats were laying low today: Senator Claire McCaskill's office sent out a one line response to the ruling:
"There's only ever been one goal for Claire—affordable, accessible health care for Missouri."
Governor Jay Nixon said in a statement, "We're just now beginning to review this ruling so that we can understand exactly what it means for Missouri. This ruling has significant complexities and implications for families, health care providers and insurers in our state."
State legislators were more outspoken.
"I think it's a victory for those without insurance," said State Representative Mary Still, Democrat from Columbia. "It's a victory for the parents of children who have pre-existing conditions -- they can no longer be denied health care coverage. It's a victory for college students and young adults looking for their first job, because they can be covered by their parents' insurance. And it's a victory for seniors: lower drug prices due to the elimination of the doughnut hole in Medicaid Part D."
She said now the biggest task in front of the Missouri legislature is to get moving on establishing the online insurance marketplace, or health insurance exchange, required by the health care law.
"We're a little behind the eight-ball, we need to scramble and get busy on this," she said. "The sooner we get up and running, the better opportunity we have to lower insurance rates."
In 2011, the Missouri House passed legislation to establish a state exchange, but the bill stalled in the Senate, thanks to Republican opposition. Senator Scott Rupp was one of the lawmakers who blocked the creation of an insurance exchange.
"It is the building block of the whole federal health care bill," said Rupp. Despite the ruling upholding the health care law, he still opposes creating an exchange.
"By refusing to do that, we are not allowing the federal health care bill to move forward in Missouri."
While the Supreme Court ruling upheld most of the law, it did limit the federal government's ability coerce states into expanding their Medicaid programs. A "silver lining for states' rights advocates," according to Republican State Representative Chris Molendorp, who chairs the health insurance committee.
He said he was surprised by the ruling this morning, but welcomed the limitations on Medicaid expansion. Molendorp has also been a longtime proponent of creating a state health insurance exchange, rather than letting the federal government do so.
"Clearly the court ruling pushes state health insurance exchanges to the forefront. I think they can operate regardless of what we do with the Medicaid population. State health insurance exchanges were designed for individuals, the self-employed, the self-proprietor out there, as well as small businesses that are having problems obtaining affordable coverage in the private marketplace."
In Missouri, there are currently about 835,000 people without health insurance. Thomas McAuliffe, with the Missouri Foundation for Health, said now that the Affordable Care Act has been upheld, the number of uninsured will be reduced significantly.
"510,000 Missourians who currently do not have insurance, will have insurance as a result of this law."
McAuliffe said with the long-awaited Supreme Court decision behind us, it's time to focus on some of the provisions of the law that aren't always in the spotlight.
"When we think about this law, so much goes into the individual mandate, so much goes into the setting up of these exchanges. But short shrift tends to go toward the role of prevention, short shrift goes toward what's already been implemented. Keeping children on until the age of 26, wildly popular."
But this is not the end of the politicized debate over the health care law. Republicans in Congress, including Missouri's delegation, have vowed to repeal the law. In fact, the U.S. House, which already voted yes to a repeal, is scheduled to vote again on July 11th.