Legislative update

DOs have mixed feelings about Supreme Court Obamacare ruling

While some DOs see the Supreme Court’s ACA decision as a step in the right direction, others find it concerning.


Last week, the U.S. Supreme Court ruled in favor of Obamacare, finding in a 6-3 ruling that the intention of the Affordable Care Act was for residents of all U.S. states to have access to health insurance subsidies. While some DOs see the decision as a step in the right direction, others find it concerning.


“About 6.5 million patients are elated, and those of us in urban areas feel relieved,” says John Sealey, DO, a current AOA Health Policy Fellow based in Detroit, who cites the number of people who might have lost their subsidies had the court ruled against the Affordable Care Act.

A cardiothoracic surgeon, Dr. Sealey says the ACA has positively impacted patients in his community, where many hospitals were struggling previously but are now more financially viable. He hopes the ruling will encourage more holdout states to expand Medicaid.

Barbara Ross-Lee, DO, who directs the AOA’s Health Policy Fellowship program, also sees states reexamining their options now.

“There’s some data now backing up the impact of providing insurance for these populations who didn’t have insurance before,” says Dr. Ross-Lee, a vice president of health sciences and medical affairs at the New York Institute of Technology in Old Westbury, the parent school of the NYIT College of Osteopathic Medicine.

But Keith Frederick, DO, a Republican member of the Missouri House of Representatives, disagrees.

“I do not believe that the Supreme Court’s decision on the subsidies will have an effect on the decision of states to expand or not expand Medicaid,” says Dr. Frederick, an orthopedic surgeon in Rolla. Missouri has not expanded Medicaid.

Alternate paths forward

Dr. Frederick finds the ruling to be a major setback for American health care. The best way to move forward, he contends, is to repeal the law entirely. In the meantime, states can develop legislation to avoid what he calls government intrusions on health care. Potential solutions for states and physicians opposed to the ACA include facilitating the direct primary care model, in part by allowing direct primary care fees to be paid from health savings accounts and expanding the use of health savings accounts, Dr. Frederick notes.

On the flip side, Dr. Ross-Lee says she’d like to see Democrats and Republicans work together to improve the ACA.

“We all recognize that the Affordable Care Act is not a perfect reform of the health care system, but it’s certainly, based upon some of the government and Medicare reports, making a difference,” she says. “If we can start there, we can probably come up with a system that works for everybody.”


  1. Maurice Robinson, D.O.

    Dr. Ross-Lee says that there is now “some data” from “government and Medicare” who have a highly vested interest in the current healthcare model. The system has been devastating to the patient/physician relationship. EMR is a complete train wreck. Medicine has always been a cottage industry. GOOD medicine will continue to be. Ivory tower thinkers with publically subsidized incomes, protections afforded by tenure, liberal political connections stemming from their support of this poorly thought out and implemented federal scheme and their limited exposure to the real world of “eat what you kill” medical business have absolutely no right to make statements as to the impact of the ACA. Just like the vaunted policy makers in Washington, Drs. Ross-Lee and Sealy have no skin in this game and should be compelled by the profession as a whole to hold their tongues and defer to REAL doctors who pound away every day under the immense and inappropriate burden that now separates us from our patients and is ravaging their healthcare options and discouraging physicians from entering primary care fields., the last great bastion of pure Osteopathy. Dr. Still must be rolling over.

  2. Paul Rein D.O

    Like it or not the ACA is doomed to failure because it is not real reform. #1- Any reform that guarantees the profits for the Insurance companies isn’t reform at all. When the insurance companies are guaranteed a profit, they simply raise the premiums and the deductibles. It is one thing to say one has insurance, it is another to really have it. #2- Reform has done nothing to conntrol prices and profits of the pharamaceutical industry. As it stands now the USA is where the industry makes it profits and then can sell the same drug in France or Canada for less money and we ask why? #3- While the hospitals may P&M about profits, check out your favorite not for profit at the website: Guidestar.org, there you will find the income tax returns of all the not for profits AND then tell me how sorry you feel for the people who run them. In Virginia in 2013 the combined profits for the not for profit hospitals was > 13 billion dollars. #4- ACA does nothing about malpractice reform. #5- ACA does nothing to allow young people to afford medical school in light of the fact there will be diminishing returns on investment. So Mr. President, nice try. Too bad our Congress fell for the infamous line of Nancy Pelosi- ” We have to pass it so we can find out what’s in it.” Can you imagine our founding fathers say such nonsense. So if we really want healthcare reform….. do it right next time.

  3. Hippocampus

    While I agree with many of the points made by Dr. Rein, the conclusions that he draws are incorrect from my perspective. ObamaCare was much closer to the universal panacea that he has enumerated as it was originally written, but of course the Public Option (in brief, a federally-provided insurance program that patients over the poverty level could pay into like insurance) was struck down by Insurance Lobbyists. That would have addressed both your “1. Insurance” point and your “2. Pharmaceutical” point, for one of the stated goals of the public option was to provide a platform for massive bargaining to bring down drug prices. Maybe in time some of the original clauses of ObamaCare will be expanded to re encompass these points, but the fact that the current legislation does not carry this option has nothing to do with a lack in the original proposal.
    And, as to your point about the fabulously painful cost of medical school, you are correct that it sucks and that ObamaCare didn’t touch it with a 10,000 foot pole. But let’s put the blame where it belongs: DO schools are incredibly expensive and nothing about the dismal economics of primary care has changed substantially in the last decade. I suspect that your favorite “nonprofit” DO school (and Rocky Vista, too) would look much like your favorite “nonprofit” hospital. Somebody is making some serious money somewhere, whether it be on the backs of primary care doctors or medical students.
    While it is valid to point out that ObamaCare does not address these issues, it is incorrect to say that this is a reason that the law should be scrapped.
    ObamaCare HAS addressed the issue of ensuring that millions more Americans have access to insurance that provides a basic minimum amount of coverage (such as covering childbirth, which a baffling number of policies formerly failed to do) and neither policies nor coverage can be withheld because of pre-existing conditions. Subsidies make it possible for many of the working poor to afford insurance– in the past 15 years of being working poor I personally have never had a job that provided affordable insurance (at one of my jobs I could have bought into the plan for the low-low-cost of my entire income PLUS 50 dollars a month– and I still would have had co-pays and a high deductible). The insurance industry is only interested in its own profits (like any other industry) and the few regulations imposed by ObamaCare have at least provided a minimum necessary framework that protects people from some of the obvious tricks.
    Yes, a plan that entirely overhauled the system, including the extremely well-monied and strongly-lobbied hospital industry, insurance industry, pharmaceutical industry, and private medical education industry would have been lovely.
    I feel that this legislation is a first step toward providing more care for more people, which is why I have taken on the awe inspiring and terrifying debt of an Osteopathic Medical Education. I may never be rich (honestly, I wonder if I will ever break even) but I will not turn people away. And with ObamaCare subsidies working to close the insurance gap between Medicaid and paid insurance I will have fewer patients who are uninsured, meaning that I will get paid something.
    But as President Obama said, “Don’t let the perfect be the enemy of the good”– or, don’t throw out the baby with the bathwater. It is not perfect, far from it. But, even on its own it will stand as a great historical achievement. Hopefully, once Dr. Rein and I are running things, it will work as a framework to expand upon.
    Of course, people (many paid by the industry giants) will scream about Socialism and price-fixing while we dismantle the insurance companies and install a single-payer system that provides fair compensation for primary care doctors. But I think it will pass, don’t you, Dr. Rein?

    1. Douglas Hargrave, D.O.

      I would agree with both Dr. Rein and Hippocampus with some of their points, but the current situation in our area is worse than ever with ACA / Obamacare. The only ones benefiting are the hospitals and insurance companies. Many patients are unable to afford the premiums even with subsidies and forego needed care. In 5 pages, they could have created a national high deductible plan with economies of scale and coverage over state lines that would have covered hospitalizations and major illnesses. For simplicity, one option could be to allow younger people to “buy in” to Medicare Part A and administer the network thru CMS. Patients would still pay upfront for regular outpatient visits and services but not go bankrupt when they need surgery or major hospitalizations. You would still get free choice on what doctor you think is worth paying to see and cut out the bloodsucking leeches of the private insurance companies. Patients would still bear some responsibility for their own health decisions / costs, like not running to the Dr. or E.D. for every sniffle or splinter like many currently do under medicaid (no copays). In my opinion, the ACA was not as much about health care, but health control. It (along with EHR, PQRS, OCC-MOL,etc.) will accelerate doctors out of private practice and into more easily controlled large hospital groups / employment models over time. Without some kind of significant change, more primary care doctors are going to retire / give up medicine. I wish us all good luck as the system continues to evolve!

  4. Michael Podolsky, D.O., F.A.O.C.R.

    The ACA was a step in the right direction and the Supreme Court helped solidify that step. Not allowing a “public option” was a grave error made by Congress in general and Republicans in particular. A large portion of health care dollars are consumed by insurance company middle men who care little for their customers, and only corporate profits. They hated the thought of competing with the Federal Government. Possibly a single payer American hybrid system is the answer. I don’t think that under one million physicians available to service 315+million Americans will suffer greatly financially.
    I live in a Texas, one of the States that refused government medicaid subsidies. There are almost one million Texans that cannot afford healthcare through the ACA but also cannot get on medicaid because of lack of federal funds and Texas ideology.
    Possibly more government and popular pressure under a different system can bring pharmaceutical costs down from the stratosphere.
    I believe that eventually a new more cost effective system will be forced upon us, so we might as well work with the present system to produce changes best for all Americans. It is in our best interest.

  5. Dudley W. Goetz,D.O.,F.A.O.C.D..

    I did not become an osteopathic dermatologist to work for a government leftist socialist program. I would sooner treat a person without charge (and have) than submit to inane demanding rules.

    It is my hope that a Republican Congress will have the intelligence and the will to overturn Obamacare.

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