South L.A. health workers have almost uniformly said it would not be good for the area if the Affordable Care Act (ACA) – specifically its provision expanding Medicaid – was to be struck down.
The high court upheld nearly the entire act, allowing the individual mandate to survive. As far as the provision expanding Medicaid, the court said that was constitutional as long as the federal government only took new expansion funds away from states that didn't want to participate in their expansion rather than all of their Medicaid funding.
Southside health workers were thrilled with the ruling. Yasser Aman, outgoing president and CEO of UMMA Community Health Clinic, said he was "elated and ecstatic."
"Today signifies a momentous moment for millions of families who have had no other options for health care coverage to now have hope they will have the necessary care their families need," he said. "It also adds a gust of wind on the sails of the health care delivery system change that is ever so needed in the U.S. health care system, to reduce cost and be innovative in delivering the most effective care to underserved, vulnerable populations."
Aman said the ruling was a victory for the "average working-class communities and the community providers that serve them."
Back in March, Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics, said that the striking down of the Medicaid expansion would have been "devastating" for the people of South Los Angeles. On Thursday she used the same word as Aman to describe how she felt about the ruling: elated.
"I actually dropped to my knees," she said. "I was really just so excited, because on a personal level, I put a lot of time and energy into what I do every day, into this law. So it was really going to be a huge game-changer for me as a health care professional, as a Democrat, as a human rights advocate."
The work that Vaccaro is referring to is her preparation of the clinics in the Southside Coalition, to help them become "the providers of choice" once folks get their coverage and have options as to where they go for medical care.
"It was a tremendous relief," Vaccaro said. "I, along with the White House and millions of people in the health care sector, am really elated by the decision."
Their reactions were echoed by health providers in the community. But a professor of health policy and economics at USC added a note of caution. The battle over health care, says professor Joel Hay, is far from over.
"I think the biggest problem with Obamacare is that it’s never been popular with the American people. I think there’s going to be – depending on who wins the House, Senate and White House in November – enormous roadblocks before implementing the Affordable Care Act," he said.
Jim Mangia, the president and CEO of St. John's Well Child and Family Center, said the ruling was "a really good thing."
"In my opinion, the most important part of the Affordable Care Act for the poor and economically disadvantaged families of the United States is that it expands Medicaid coverage for adults," he said. "The law expands it and essentially provides public health insurance for everyone who's been a naturalized citizen for at least five years. That's thousands of our patients." Mangia had previously said that if the law were struck down, that would have effectively conveyed the message that "the American people don't have a right to health."
Felix Aguilar, the chief medical officer at South Central Family Health Center, also told OnCentral that the "best-case scenario" would be for the entire law to be upheld, because that would give many more of his patients access to coverage.
Brietta Clark, a professor of law at Loyola Law School who specializes in health care law and access issues, said the ruling brought tears to her eyes.
"I've been texting with my mom back and forth, and she had the best quote: 'I guess the constitutional law professor knew what he was doing'," she laughed. Clark's mom was referring to President Barack Obama.
The professor said she was surprised by the ruling, in particular the grounds upon which the mandate was upheld – and the fact that it was upheld at all. As far as the Medicaid expansion, she said she wasn't shocked they both upheld and limited it.
"I think the fact they upheld the expansion is critical for the states and people in poverty," she said. "But the court is basically saying the federal government can't terminate all [of a state's Medicaid] funds and they can't require states to participate in this Medicaid expansion, which means a lot of people still won't be able to benefit from it." That creates much greater inconsistency among the states as it relates to Medicaid, she explained – and since there already was inconsistency, "this is going to make it worse."
As far as the states who do want the expansion, Clark said it was a "huge win."
"The reason tears came to my eyes is because I really felt like this was our last chance to try to comprehensively overhaul our system to make insurance affordable and accessible for people," she said. "I don't know if it will work, I can't predict that, but if this had gotten struck down, there would not have been another chance. So to have it upheld, I felt like – wow, we can really do something with this. We can make it so much better. We can really expand coverage."
Clark says now it's time to look to implementation. Vaccaro agreed.
"We still have about 130 days until the election," said Vaccaro. "We keep moving forward until we are told otherwise. I think we just keep down the same path we've been going, working really hard to get clinics ready so they've got the capacity that they need, so that we've got enough doctors to meet the demand in our community." Vaccaro also mentioned that clinics on the southside – and everywhere – need to prepare for caring for those who still won't be covered after health care reform is in full effect.
Aman echoed the sentiment that this ruling does not mark an endpoint – just an obstacle cleared.
"This is not a time to relax," he said. "The challenges are still ahead of us, but this major hurdle is now behind us. We now have to roll up our sleeves and get to work."