Court ruling lets insurers, hospitals exhale, prepare

"We are very glad to have the ruling behind us so that we have certainty, at least for now, that we need to continue our efforts to comply with the law," said Barbara Morales Burke, vice president for health policy at Blue Cross Blue Shield of North Carolina, the state's largest insurer.

Dr. Victor Dzau, chief executive of Duke University Health System, said the ruling provides the industry with needed direction.

"For a while, there's all this speculation – where is this going to go? I think having clarity is very important because now we can move forward," Dzau said.

Duke Health has expanded its presence across the Triangle as a primary health care provider to prepare for the expansion of coverage that the law will bring.

"We need to be prepared to have a sufficient number of providers to take care of this demand," Dzau said. "(People) can have access to care – primary care and prevention – and reduce the use of emergency rooms. So, (people are) coming in the front door of the health care system rather than the backdoor."

The North Carolina Medical Society said a number of issues still need to be addressed for health reform to be successful in the U.S., such as the cost and financing of existing government-sponsored health coverage programs and widespread physician shortages.

Insurers agreed that the Patient Protection and Affordable Care Act should be only the first step in reining in medical costs nationwide.

"Much more must be done to fix the problems that remain in our health care system. We believe there is still time – if people can come together in a bipartisan way – to improve quality and affordability," Aetna spokeswoman Susan Millerick said in a statement.

"The health care reform law falls short in controlling the underlying cause of our nation’s health care crisis – costs that are too high and rising too fast. Affordable and stable coverage must be our top priority," Humana Chairman and Chief Executive Michael McCallister said in a statement.

“Health care modernization did not begin and must not end with the enactment of the Patient Protection and Affordable Care Act," UnitedHealthcare spokeswoman Tracey Lempner said in a statement. "Now is the time to apply proven ideas and best practices to build a better health care system.”

All of the companies said they wanted to work with both Democratic and Republican policymakers to build on the Affordable Care Act.

"We know we need to continue as we have been in focusing on improving health care quality and affordability," Burke said.

Dzau said he's confident that the law will fix many problems in the nation's health care system.

"Providing good quality care – affordable care – and access to health care for everybody who needs is the right philosophy and the right values," he said.

Burke said it was important to keep the so-called individual mandate in place to help insurers pay for other provisions of the law, such as eliminating lifetime caps on coverage and preventing insurers from denying coverage of pre-existing conditions. The mandate, which requires everyone to have health coverage by 2014 or face financial penalties, was a critical element of the law that the Supreme Court narrowly upheld.

"We do believe that it's important and a good thing that those provisions remain able to work together," she said.

Insurers said it's too early to determine the law's cost impact on people's health policies.

"We can expect changes in the future when it comes to what coverage costs, and it's very complex. Not everyone will be impacted the same way," Burke said.

But she stressed that customers should relax now that the court has determined the law is legal. "Nothing is changing for them. Their coverage remains as it has been," she said.