At least 60,000 Sonoma County residents who currently have no health insurance could soon benefit from the U.S. Supreme Court's decision Thursday to uphold the bulk of President Obama's health care law, local health officials said.
Even as critics of the law vow to turn the court's ruling into an election year referendum on Obama, local health care officials resoundingly approved the decision.
"Fewer people will die, fall ill, or lose their homes because of the lack health insurance," said Sonoma County Health Officer Lynn Silver-Chalfin. "Prevention will continue to be supported."
Jerry Dunn, interim director of the Sonoma County Human Services Department, said the decision ensures medical insurance access to 60,000 previously uninsured residents, more than 10 percent of the county's population.
"I'm delighted by the decision of the Supreme Court," Dunn said. "It ensures that members of the community who don't have access to health care now have it."
Under the health care law, those who do not have health insurance will be required to purchase it or face a penalty. The law was challenged by critics who said that provision, known as the individual mandate, was unconstitutional and overreaching.
But Chief Justice John Roberts, siding with the court's liberal wing, said the individual mandate was in effect a tax established by Congress.
Republican Dan Roberts, who faces Assemblyman Jared Huffman, D-San Rafael, in the race for the 2nd Congressional District, said he would support a move to repeal the law under a new president, though he admitted doing so would be difficult without a 60-member majority in the Senate.
"It has allowed a Democrat to go on a typical tax and spend rant, which needs to be stopped," said Roberts, adding that he supports a "free market" overhaul to the health care industry.
Mary Maddux-Gonzalez, the former county health officer who now heads a consortium of Northern California community health centers, said the court's decision paves the way for a transformation of the nation's health care system to one that could lead to a greater focus on preventative health care.
"We have a disease system and need to shift the focus to a health system," said Maddux-Gonzalez, who is the chief medical officer and chief executive of the Redwood Community Health Coalition.
Maddux-Gonzalez estimated that 70,000 county residents currently do not have health insurance, a number slighter higher than the county's.
She said that in 2014, when the law becomes fully implemented, about 30,000 of these residents will have access to commercial insurance exchanges, in which premiums are subsidized by tax credits. That same year, another 20,000 uninsured residents may receive insurance through an expansion of Medicaid.
Three programs, Medi-Cal, expanded Medicaid and the subsidized health exchanges will work in concert, county officials said.
Medi-Cal will continue to cover residents with incomes up to 66 percent of the federal poverty level.
Expanded Medicaid will cover incomes from 66 to 133 percent of poverty.
Insurance through health exchanges will be available to those whose incomes are between 133 and 400 percent of the poverty line, where 133 percent is $14,850 for an individual and $30,650 for a family of four in 2012.
Under the exhange program, insurance coverage would be heavily subsidized for low-income individuals and families. The level of subsidy would decrease at higher income levels.
The fee or penalty for not having insurance in 2014 would be $95, or one percent of income for individuals, whichever is higher. For a household of three or more, the fine would be $285 per family or one percent of income, whichever is greater.
The fine would increase each year and by 2016 would rise to $2,085 for a household or 2.5 percent of income.
Naomi Fuchs, CEO of Santa Rosa Community Health Centers, said many of those who are currently uninsured are now seen at local health centers. "But a lot don't get health care anywhere," she said.
Petaluma Health Center CEO Kathie Powell said her center expects to care for an additional 5,000 patients in the coming years.
The $9 million grant the center received in federal stimulus funding for its new 53,000 square-foot building was part of a federal effort to bolster capacity at federally qualified health centers in anticipation of the new health care law.
North Coast Democrats joined a chorus of praise that spread across the country within minutes of the court's decision.
"I am grateful that the Supreme Court put partisanship aside and affirmed the will of the people, as expressed through their elected representatives in Congress and the White House," said Rep. Lynn Woolsey, D-Petaluma.
Congressman Mike Thompson, D-St. Helena, said in a statement that the health care law is already "saving money and saving lives."
Reaction among local hospital officials was mostly positive. In crafting the federal health care law, the government zeroed in on hospital costs in an attempt to move toward a performance-based payment system.
The law rewards hospitals that can deliver improved care to Medicare patients and punishes those who can't.
"From a personal standpoint I was pleased that it was upheld," said Mike Purvis, chief administrative officer for Sutter Health Medical Center of Santa Rosa. "We do need to see our health care system change and evolve."
But Purvis said the law does not provide a clear enough "pathway" for creating a health care system that financially rewards improved health outcomes.
Kevin Klockenga, president and CEO of St. Joseph Health, Sonoma County, which operates both Petaluma Valley Hospital and Santa Rosa Memorial Hospital, said the law is key to expanding coverage in Sonoma County.
"We understand how families and employers are struggling and we are extremely concerned about the accessibility and affordibility of health care services," he said.
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