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Supporters for the health care reform law on Monday rally in front of the Supreme Court in Washington, D.C. The court on Monday begain three days of arguments on health care.

The Associated Press

They’re not taking a position on the constitutionality of the law, but officials of Joplin hospitals are among those watching carefully as the U.S. Supreme Court takes up state challenges of federal health care reform.

Parts of the law may stand even if the court overturns the most controversial element, a mandate requiring individuals to buy health insurance, pointed out Scott Watson, vice president of human resources and support services for Mercy Hospital Joplin.

“The justices are the only ones who are going to determine that (purchase mandate),” said Watson, who is an attorney. “But not all provisions of the bill are under challenge, so people shouldn’t think that all of it will necessarily go away.”

That would be the goal of many Republican lawmakers, including U.S. Sen. Roy Blunt of Missouri, who say the court should invalidate the measure and Congress should repeal it.

“It’s clear to the majority of Americans that this burdensome and costly legislation is bad for families, seniors and job creators,” Blunt said in a statement Monday. “No matter what the Supreme Court ultimately decides, I believe the president’s health care takeover represents an unmitigated intrusion into Americans’ fundamental rights and freedom. That’s why we must work together to repeal this flawed law and enact common-sense bipartisan solutions that will put patients and doctors in control of their health care — not Washington bureaucrats.”

U.S. Sen. Claire McCaskill, D-Mo., who voted for the bill when it was passed two years ago, said she is hearing from Missouri residents who like elements of the measure.

“Most Missourians I encounter really like the fact that their children can stay on their polices,” she said in a statement. “Most seniors really like that we’re filling the donut hole in the prescription drug program. And most people are extremely excited about doing away with the ban on pre-existing conditions.

“So I think people who want to repeal the bill don’t realize how popular those parts of the bill actually are.”

Watson said Sisters of Mercy Health System has no formal position for or against the law under challenge.

“But,” he said, “we are quite certain that 49 million people under the age of 65 without health insurance is something that cannot be sustained. Of that number, 75 percent are from working families, so you can’t classify it as falling in any particular socioeconomic area.”

Any growth in the number of uninsured adds to the challenge, Watson said, because those patients do get care — in hospital emergency rooms.

“That’s the most expensive care out there,” he said. “Those costs get divided up and passed along to everyone.”

Care that starts with prevention is the most cost-effective “and must be a huge part of going forward,” Watson said.

“We believe all persons have the right to affordable and accessible health care, and that barriers to that have to be addressed,” he said. “We also believe that providers should be justly reimbursed for the work they do.”

Information on Mercy’s losses, in costs to care for uninsured patients, was not available Monday.

At Freeman Health System, that amounts to $16 million in an average year, a spokesman said. The total was $23 million in a yearlong period that ended March 21 and included effects of the May 22 tornado.

“While the Affordable Care Act is sure to result in many changes for Freeman Health System, those aspects of the law that will make the greatest impact are yet to be implemented,” said Steve Gaddy, Freeman chief financial officer. “We anticipate the mandate scheduled to begin in 2014, which will require all Americans to have health insurance, will provide the greatest source of change.”

The biggest issue before the court is today’s argument over the constitutionality of the individual insurance requirement. The states challenging the law and the National Federation of Independent Business say Congress lacked authority under the Constitution for its unprecedented step of forcing Americans to buy insurance whether they want it or not.

The administration argues that Congress has ample authority to do what it did. If its action was rare, it is only because Congress was dealing with a problem that has stymied Democratic and Republican administrations for many decades: how to get adequate health care to as many people as possible, and at a reasonable cost.

The justices also will take up whether the rest of the law can remain in place if the insurance mandate falls and, separately, whether Congress lacked the power to expand the Medicaid program to cover 15 million low-income people who currently earn too much to qualify.

If upheld, the law will force dramatic changes in the way insurance companies do business, including forbidding them from denying coverage because of pre-existing medical conditions and limiting how much they can charge older people.

The law envisions that insurers will be able to accommodate older and sicker people without facing financial ruin because of its most disputed element, the requirement that Americans have insurance or pay a penalty.

By 2019, about 95 percent of the country will have health insurance if the law is allowed to take full effect, the Congressional Budget Office estimates.

Reams of court filings attest that the changes are being counted on by people with chronic diseases, touted by women who have been denied coverage for their pregnancies, and backed by Americans over 50 but not yet old enough to qualify for Medicare who face age-inflated insurance premiums.

THE ASSOCIATED PRESS contributed to this report.

Filling the gap

THE COMMUNITY CLINIC OF JOPLIN is one of the organizations providing medical care to area residents without health insurance. The clinic was averaging about 2,500 individual patients annually before the tornado, and the number has grown since “to probably double that,” said Barbie Bilton, executive director.

“THEY MOVE ON as they become eligible for other services, like Medicaid,” she said. “Our hope is that they can get permanent, ongoing health care that is more stable.”

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