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Ga. officials waiting to implement health law
Insurance mandate ruled constitutional as chief justice is swing vote in 5-4 opinion
The justices of the U.S. Supreme Court are shown in a 2010 photo. Seated from left are Associate Justices Clarence Thomas, and Antonin Scalia, Chief Justice John Roberts, Associate Justices Anthony M. Kennedy and Ruth Bader Ginsburg. Standing, from left are Associate Justices Sonia Sotomayor, Stephen Breyer, Samuel Alito Jr., and Elena Kagan. The Supreme Court today upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.

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Reaction to the Supreme Court ruling:

“This is a dark day in our history. While I’m disappointed in the Supreme Court’s decision, I’m more resolved than ever to repealing this law in its entirety. ... First the President told us the individual mandate was not a tax. Now, the high court is telling us it is a tax. What’s clear from today’s ruling is there are now no limits to how the federal government can tax the American people. This is not the America I know and love. House Republicans are firmly commited to removing this entire law. Once that work is done, and the nightmare known as Obamacare is fully behind us, we must engage in a thoughtful, common-sense approach to reforming health care in America. Any reforms we undertake pertaining to health care must let families make their own health choices and preserve the doctor-patient relationship. It’s time for a patient-centered, patient-driven, free market-focused solution for health care.”
U.S. Rep. Tom Graves, R-9th District

‘We are greatly disappointed in the decision rendered today by the Supreme Court and believe that the path on which our nation is being forced to move forward will be detrimental to both employers and employees throughout the nation as a result of increased costs and new regulations. Businesses will be forced to make difficult decisions that will likely result in employees losing their employer-provided coverage. Our organization will look forward to working with the Governor and other leaders at the state and federal level to implement the law in a way that takes into account the important role businesses play by providing this important benefit and the overall impact on our economy.’
Georgia Chamber of Commerce President and CEO Chris Clark

“Despite today’s ruling by the U.S. Supreme Court, the Republican Party will continue to work for patient-centered, affordable and long-term health care solutions. We believe that the patient comes before the bureaucrat, and that the single most important relationship in the health care sector is between the patient and their doctor, not the patient and the government. Mitt Romney has already declared his intent to repeal and replace ObamaCare on day one, and I am proud to stand behind his efforts. I applaud Gov. Romney for standing up for our Constitution, and look forward to working with our Republican leadership across the country to provide common-sense health care options to all Americans.”
Georgia Republican Party Chairman Sue P. Everhart

“This is a great day for all Americans. The Supreme Court rejected partisan politics and put the welfare of the people first. This decision will allow all Americans to be secure in the knowledge that if they get sick, they will have high quality and affordable health care to help them get well. It also means that children and adults will no longer be denied health care due to pre-existing conditions and young adults will be coved under their parents’ health insurance up to age 26."
Georgia Democratic Party Chairman Mike Berlon

“Young Georgians will continue to benefit from President Obama’s Affordable Care Act, particularly those provisions that allow them to stay on their parents’ insurance up until age 26 and forbid discrimination against people based on any preexisting conditions they may have. While we are grateful for the decision, we know that there will still be obstacles ahead as those who disagree will continue to obstruct progress. We are ready to fight to protect this decision, and do all that we can to ensure that President Obama is re-elected to a second term so that he can continue to fight for the progressive change this country deserves.”

Louis Elrod, president of the Young Democrats of Gerogia

“The Founding Fathers would be mortified to see the body blow to their hard-won concept of America’s limited government. Congress now has the power to do whatever it wants. This flawed decision highlights the urgent need for state action to protect taxpayers and health care consumers from the harmful effects of this law. The solution to this nation’s health care problems certainly are not in Washington, D.C., and this ruling reinforces our commitment to work harder than ever to restore the proper balance of individual rights and government power in Georgia and in Washington. ... As a free-market think tank, we exist to defend the liberty of Georgians from state and federal government encroachments. We will redouble that effort as we advance the goals of better health care for all Georgians.”
Kelly McCutchen, president of the Georgia Public Policy Foundation

“I disagree with this decision. Congress explicitly said this was not a tax. I call on Congress to act swiftly, repeal the law and replace it with real reform that respects the Constitution as written.”
Sam Olens, Georgia attorney general

“These cost control-driven entities must change the way they pay physicians or we simply won’t have enough physicians to care for patients. We also should be alarmed that we are losing our freedom and autonomy as patients and physicians with each passing day.”
Sandra B. Reed, M.D., president of the Medical Association of Georgia

In the aftermath of the U.S. Supreme Court’s ruling that President Barack Obama’s health care overhaul was largely constitutional, Georgia lawmakers are playing the waiting game.

But some health care professionals say they’ve been quietly preparing for the new reality all along.

Republican Gov. Nathan Deal said Thursday that state officials will wait until after the November elections to implement the law.

An opponent of the sweeping health care changes, Deal is hoping that Republican Mitt Romney wins the White House and the GOP keeps its House majority and wins the Senate, putting the Republicans in a position to repeal or gut the law.

Deal signaled he was in no rush to implement it even as Democrats called on him to quickly move forward.
“We are probably just going to be in a holding pattern until such time as we see what the events of November bring us,” Deal told reporters during a Capitol news conference.

Jeff Reinhardt, M.D., president of The Longstreet Clinic, said he wasn’t surprised by Thursday’s ruling and that Longstreet has been quietly making preparations for the new law.

He said those in the health care industry have known for 20 years that they needed to change the way they practiced medicine.

“This is something that was no surprise — it was no surprise it was made law to begin with — and so we’ve sort of been preparing ourselves all along to practice medicine in the new environment of medical care,” Reinhardt said.

In the political world, Deal’s stance foreshadows the practical difficulties the Obama administration faces in implementing its signature domestic policy in the middle of a presidential campaign.

While the nation’s top court generally found in favor of the law, it faces staunch resistance from Republican state officials tasked with turning that law into reality.

“The medical system was broken before, and now it’s broke,” said Rep. Carl Rogers, R-Gainesville.

Rogers said he liked pieces of the bill, including a provision that keeps insurance companies from discriminating against those with pre-existing conditions. But he likened the requirements the law puts on states to a hostage situation.

“I’ve always felt that the health care companies, especially on individual coverage, they were looking at the special specimen of an individual and if you had anything and everything wrong, they would turn you down,” Rogers said. “I think in the beginning of this, that should have been addressed and not just a 2,700-page bill to drive us towards socialized medicine — and that’s exactly what that administration wants us to do.”

With a General Assembly dominated by that Republican line of reasoning, now stymied in the courts, state leaders could choose to drag their feet in implementing the law.

The decision sets up a political dilemma for Deal, who used his last vote as a congressman to oppose the health care proposal.

Up for re-election in two years, Deal faces a conservative base of voters who oppose the law’s requirement that almost all Americans buy health insurance or face a tax penalty. At the same time, Deal said the court’s ruling leaves him with limited discretion — a measured stance that could upset die-hard conservatives.

“I’d like him to say I’m not going to follow it, but I don’t think that’s going to happen,” said Debbie Whelchel, 49, of Suwanee, an opponent of the law who joined a small tea party rally at the Capitol just before the court ruled. “That’s what I would like to see happen. Honestly, I’m so disappointed.”

Georgia’s leaders were noncommittal on two of the largest health care-related decisions they face.

State officials must tell the federal government by Nov. 16 whether Georgia will run required health information exchanges — networks allowing residents to purchase approved plans under the law — or let the federal government do it. The state could also decide to manage some parts of the exchange but not others. That decision must be made just days after the presidential election, and Deal said his administration may ask for an extension until state lawmakers return in January.

Sen. Butch Miller, a Republican from Flowery Branch, said lawmakers are still trying to get their “arms around” the specific impacts of the ruling.

“I am clearly disappointed in the court’s ruling,” Miller said. “In my view, it just goes against everything that I believe is the proper role of government. Since when did Congress require or mandate that the American public buy a particular product and then penalize you if you didn’t buy it?”

But he said lawmakers have already done some work toward implementing the exchanges.

“We’ve done a lot of preliminary work on that in the event that this ruling did come down,” Miller said.

Deal was noncommittal on whether Georgia would expand its Medicaid program, a government-funded health care system that serves the needy, aged, blind, disabled and poor families with children.

The Supreme Court’s ruling struck down part of the law that required states to expand the program or lose their federal Medicaid funding.

Now that choice is voluntary. If Georgia makes such an expansion, Deal’s administration estimates 620,000 people would join the government-run health plan in 2014. Over a decade, it would cost the state an estimated $4.5 billion in additional expenses.

“This is a federal unfunded mandate,” Rogers, of Gainesville, said.

Republicans have also claimed the bill would eventually result in lower quality medical care.

But Reinhardt, of The Longstreet Clinic, said that’s not the case — at least not in his business.

“I personally don’t think it changes anything in terms of how we’re caring for patients over here,” Reinhardt said.

Mimi Collins, chief executive officer of The Longstreet Clinic, said there will be changes with the way doctors deal with insurance companies. Insurance companies, she said, are now scoring medical facilities on results.

“That’s very different than five years ago when it was all about financials,” Collins said.

Patients, she said, will receive more integrated care as a result of the law: Data, like images of CT scans, will be shared electronically among physicians, and physicians will become more aggressive in achieving results for treatments.

“I think you will see more and more reliance on actual data in how we deliver health care and how physicians communicate with each other about patients and how patients communicate with their physician,” she said.

But that creates challenges for doctors, who may not all be on the same page with technology or have the same ability to relay information accurately.

“It’s a process of education on both sides,” said Reinhardt. “That’s a new thing for us to be doing, too.”

But practical effects of the law — how it might affect a patient’s experience or a physician’s costs — were largely lost in the political rhetoric Thursday, as each side claimed victory or promised not to concede defeat.

Democratic lawmakers called Thursday’s ruling a victory and urged Republicans like Deal to put the law into action. Democratic state Sen. Vincent Fort said small-government ideology has not stopped Republicans from taking cash from the Obama administration before. For example, former Republican Gov. Sonny Perdue accepted federal stimulus funds despite political misgivings. Georgia cut money from its state budget during the recession, but the stimulus funding meant those cuts were not as deep as they could have been.

“However much they whined about it, they took the money,” Fort said. “And that’s what they ought to do. Be responsible. There are Georgians in a time of economic crisis that we’re in today, we need Gov. Deal and the Republicans to stand up, be responsible, make sure that more Georgians get health care, that Medicaid is expanded in a responsible way.”

Georgia’s congressional Republicans immediately denounced the ruling, promising to repeal the bill. Rep. Jack Kingston wrote on Twitter to rebuke Chief Justice John Roberts, an appointee of Republican President George W. Bush. Roberts voted with the majority to back the law.

“I feel like I just lost two great friends: America and Justice Roberts,” Kingston said.

Democratic Rep. John Barrow, who voted against the health care law, is running for re-election and walked a middle-of-the-road line.

“We have to cut spending and cut health costs, but its starts with rejecting the false choice being offered by both parties, that it’s all or nothing,” Barrow said.

Others like 9th District Rep. Tom Graves asked their supporters for political donations, saying only the ballot box can undo the court’s ruling.

“A full repeal of this law is now our only option, but that can only happen if we elect more conservatives to the U.S. House, U.S. Senate, and Mitt Romney as the President of the United States,” Graves told supporters in an email.

And like Deal, state Rep. Emory Dunahoo, R-Oakwood, placed hopes in the election of a Republican president in November.

“Romney, if he wins, will have to repeal it or at least try,” Dunahoo said.

If that doesn’t happen, Dunahoo said he’d support something a little more drastic: secession.

“If the federal government can’t get it right, I have no problem with us doing our own in Georgia. I really don’t — pulling out of the federal government,” Dunahoo said.

The Associated Press contributed to this report.