WAILUKU - The U.S. Supreme Court's decision to uphold President Barack Obama's Affordable Care Act came as good news Thursday for patients and health care workers at the Malama I Ke Ola Health Center in Wailuku.
"The bottom line is it's going to allow health centers such as ours to expand access to cost-effective and affordable health care," said center Executive Director Dana Alonzo-Howeth.
And that means the center, formerly known as the Community Clinic of Maui, will be a more effective "safety net provider," ensuring that people who can't afford insurance get health care, she said.
If the law had been struck down by the high court, "it's questionable how secure our funding sources would have been long term," Alonzo-Howeth said.
In May, the Wailuku health center received $4.6 million as part of $10 million awarded to three Hawaii health centers under the Affordable Care Act, the president's health reform measure. The other centers were the West Hawaii Community Health Center in Kailua-Kona, $5 million; and the Bay Clinic in Hilo, $500,000.
Nationwide, the health care law provides $9.5 billion to expand services at community health centers over five years. It also sets aside $1.5 billion to support major construction and renovation projects at the centers.
Alonzo-Howeth said the $4.6 million grant will pay for the completion of renovations to another 14,000 square feet at the former Ooka Super Market building. The money also will pay for exam tables, equipment and whatever else is needed to completely outfit the facility, she said.
The facility serves people who are unemployed, have a limited income and simply can't afford health insurance, she said. The law "is going to enable our health center to serve more of those folks."
A 2010 news release announcing a $25,000 grant from The Harry and Jeanette Weinberg Foundation indicated that the clinic was serving about 8,000 clients annually.
Alonzo-Howeth estimated that the funding and expansion would allow the health center to serve an additional 5,000 people over a few years and perhaps double that amount if more funding becomes available.
"It's really a vehicle to help improve the quality of health in our communities," she said.
The high court's action brought optimism mixed with caution from Dr. William Mitchell, president and chief executive officer of Maui Medical Group, which has a staff of 70 doctors and other health care providers.
"We welcome improved health care for all our citizens," he said, cautioning that there are gaps in insurance coverage for some groups, such as those who are unemployed and those with pre-existing illnesses who can't get health insurance coverage.
As a health care provider, Maui Medical Group is concerned with increased government regulation and a higher cost of doing business, Mitchell said. He said it isn't clear what will happen with health care costs after Thursday's ruling.
"We're in a wait-and-see mode," he said, adding that "no matter what," Maui Medical Group would provide quality health care.
"We're rolling with the punches here," he said.
Wesley Lo, Maui Memorial Medical Center's chief executive officer, said that the Supreme Court's action helps clarify the direction health care is taking in the United States but much remains uncertain.
"The initial health care act was an important stimulus for health care to make some much-needed changes," he said. "The Supreme Court ruling affirms that direction while providing stability to an industry that is volatile enough without constantly changing regulation."
"While we aren't certain what the final outcomes will be, it allows those of us in the industry to continue down the path of providing access to quality health care in the most desirable manner," Lo said.
Gov. Neil Abercrombie pointed out that Hawaii already has its Prepaid Health Care Act, which "enables a vast majority of our residents to be insured."
The Hawaii law, on the books since 1974, requires employers to provide health care coverage to employees who work at least 20 hours per week. Employers can ask each employee to pay only up to half of their monthly premiums - and only if that amount doesn't exceed 1.5 percent of the worker's gross monthly income.
According to U.S. Census data, roughly 97,000 Hawaii residents, or 7.7 percent, are without health insurance - the second lowest in the country behind Massachusetts at 5.5 percent.
Pat McManaman, the state's director of the Department of Human Services, said Hawaii could end up with an even lower rate than Massachusetts after the federal law fully kicks in.
McManaman said that Hawaii would not pull back its commitment to Medicaid coverage. The justices ruled that the federal government can expand the Medicaid program but cannot threaten the entire Medicaid allotment for states that choose not to take part in the expansion.
Starting next month, Hawaii's eligibility requirements for Medicaid will be in line with federal guidelines under the health care overhaul, meaning an additional 24,000 people who weren't previously insured will be newly eligible for Medicaid, McManaman said.
U.S. Sens. Daniel Inouye and Daniel Akaka applauded the ruling.
"The Affordable Care Act may now fulfill its full promise to bring quality health care to millions more Americans, combat skyrocketing costs and lower the burden of uninsured patients on our hospitals and doctors," said Akaka, who is retiring from the Senate.
Candidates seeking to fill Akaka's seat also weighed in.
Democratic U.S. Rep. Mazie Hirono said: "This ruling means that Americans can now count on secure and stable insurance coverage. If you have a pre-existing condition, you'll be able to get health care; if you become seriously ill, there will be no annual limits on your care; if you're a woman, you won't be charged higher premiums; and if you don't have coverage, you will be able to buy affordable coverage."
Former Congressman Ed Case, who is challenging Hirono for the Democratic nomination, said the health care law "contains key provisions that, if implemented properly, can improve health care in Hawaii."
But he said that the law "does not address the growing crisis in provider availability and services, especially on the Neighbor Islands, driven largely by crushing Medicare paperwork and discriminatorily low Medicare reimbursements."
Former Gov. Linda Lingle, the likely Republican nominee for the Senate seat, said that the high court's action is "not the end, but the beginning of what can and should be a healthy, productive and successful revamping of medical care access for the people of Hawaii and the nation."
Lingle said that, beginning in January, the next Congress will need to address what the health care law "ignored." Those issues include "the skyrocketing health care costs for the majority of Americans and small businesses, the quality of health care Americans receive, and the limited access to care for those in rural and remote areas," she said.
Lingle said that the law contains "questionable policy judgments," such as the decision to create unelected independent review boards, the "punitive" tax on medical device manufacturers and the elimination of Medicare Advantage programs.
"We need to seriously consider these issues if we are to truly meet the health care needs of our country, without pushing it further into debt," she said.
Lingle did not call for a repeal of the health care law as other Republicans have.
Three health insurance companies doing business in Hawaii issued statements on the ruling ranging from generally supporting health reform to "tremendous relief" that the court upheld the health care act.
"We are strong advocates for health care reform and access to quality, affordable health care for Hawaii's people," said Robert P. Hiam, chief executive officer of Hawaii Medical Service Association, Hawaii's largest health care insurer. "HMSA's effort to increase access to care, slow the growth of health care costs and support preventative health, individual responsibility and transparency were under way long before the Affordable Care Act became law in 2010."
John Henry Felix, chairman, president and CEO of Hawaii Medical Assurance Association, said: "HMAA has for some time been fully prepared to do everything necessary to conform to the requirements of the Affordable Care Act, and the U.S. Supreme Court's decision only reaffirms our commitment to continue providing Hawaii businesses and their employees with superior health insurance benefits. . . .
"The court's decision will not affect HMAA's ability to continue offering cost-effective health plan solutions for businesses in Hawaii."
John McComas, CEO of AlohaCare, said that the ruling was "a tremendous relief for those of us who believe all people deserve excellent, efficient and affordable health care." AlohaCare is the state's third-largest health insurer and the state's largest "safety net" health plan.
* The Associated Press contributed to this report. Brian Perry can be reached at bperry@mauinews.com.
