Just after 9 am CST, the Supreme Court ruled 5-4 to uphold the major tenets of the Affordable Care Act. While it was ruled Congress could not mandate an individual buy insurance, the High Court said Congress could tax individuals who do not do so at a higher rate ... ultimately, tweaking the law's wording but upholding the central premise that those who can must either purchase insurance or face a tax. The ruling was considered a major win for the Obama Administration and the president's signature piece of legislation. Below are reactions from a number of major consumer and healthcare organizations.


And for more news from our sister publicaton, Nashville Post, please go to: 

• Decision Day Upheld

• State Politicians React 

And for breakdowns on what the law means going forward, please see the following briefs from area and national healthcare experts:

Baker, Donelson, Bearman Caldwell & Berkowitz

Kraft CPAs

HHS Guidance on Insurance Exchanges

Bass, Berry Sims Webinar July 2, Registration & Info

Scott Raynes, Chairman, Tennessee Hospital Association & CEO, NorthCrest Medical Center - Springfield

Today, the United States Supreme Court announced its decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA).  Though the opinion still is being fully interpreted, it appears the court upheld the validity of most of the key provisions of the ACA. Though much work remains to be done on all fronts, the Tennessee Hospital Association believes the court’s action is an important step toward meaningful health reform. Such reform will help to preserve access to quality care for patients in Tennessee.
While Tennessee hospitals are making demonstrable strides in decreasing the cost of care through nationally recognized
patient safety programs and aggressive efficiency measures, systemic change is imperative. Last year, Tennessee’s hospitals provided $2.4 billion in uncompensated care as a result of the high number of people who are uninsured or under-insured.  With basic health coverage for all in Tennessee, hospitals are in a better position to absorb the $4.3 billion in cuts that will be required of them under the ACA over a 10-year period. Hospitals will continue to do their part to provide access to high-quality care for patients and communities they serve.  


Statement from Wiley T. Robinson, MD, President Tennessee Medical Association 

Until the Supreme Court made its decision, we had to take tentative steps toward change. Today’s decision allows us to make more definitive plans regarding reforms to our healthcare system in Tennessee. We are surprised by this ruling but have been working to develop resources for our members to explain the Affordable Care Act provisions that will impact their patients and their practices.

While the decision has a certain finality, we all need to understand that healthcare reform remains a fluid process. The TMA stands by the principles it feels are necessary to create a better environment for patients and physicians. 

Physicians remain concerned about the lack of efforts to reduce wasteful hassles and regulations, the creation of an unaccountable, dictatorial oversight board (IPAB), lawsuit abuse, the unwillingness of Congress to fix the Medicare fee schedule for physicians, the limited supply of physicians to care for an expanded patient base, and the rights of patients to choose who provides their medical care. 

As healthcare reform continues to evolve, the TMA will stay focused on supporting what we see as helpful to our patients and fighting those provisions that threaten good medicine.”


AMA: Supreme Court Decision Protects Much-Needed Health Insurance Coverage for Millions of Americans

Statement by Jeremy Lazarus, MD, President AMA

The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay
healthy. The AMA remains committed to working on behalf of America's physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation's healthcare system.

This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded healthcare coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans. 

The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.


Statement by Rich Umbdenstock, President and CEO, American Hospital Association


Today’s historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality. The decision means that hospitals now have much-needed clarity to continue on their path toward transformation. But transforming the delivery of healthcare will take much more than the strike of a gavel or stroke of a pen. It calls for the entire healthcare community to continue to work together, along with patients and purchasers, to implement better coordinated, high-quality care. 

Now that the Supreme Court has made its decision, hospitals will continue their efforts to improve the law for patients, families and communities.

Statement from Mary Bufwack, CEO of United Neighborhood Health Services

We estimate that 55,000 currently uninsured people in Nashville/Davidson County will gain insurance and access to health care over the next few years because the U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act. These uninsured people will gain coverage under Medicaid expansion in 2014 or because they will be able to afford to purchase of coverage through the new state Health Insurance Exchange.

Many of the 55,000 who will gain coverage live and work in the communities that are served by    United Neighborhood Health Services.  As a health care advocate, United Neighborhood Health  Services will take an active role in creating public awareness and understanding of the law’s  benefits and protections. We will help community residents who qualify to enroll with their Medicaid  agencies and the Exchanges so that they are able to gain the coverage they need and deserve.

However, it is estimated that over 35,000 people in Nashville/Davidson County will remain uninsured despite the provisions of the Affordable Care Act.  United Neighborhood Health Services will continue to reach out to this group and provide a full range of primary health services.


Statement from American Heart Association CEO Nancy Brown: Patients Are the Victors in Affordable Care Ruling

The historic decision handed down today will benefit America’s heart health for decades to come. Questions about the Affordable Care Act’s constitutionality have overshadowed the law’s progress. With this ruling, that uncertainty has finally been put to rest.  

By upholding the law, the nation’s highest court has sent a clear message that patients should be the first priority in an ever-changing healthcare arena. The court’s action in support of the ACA helps remind us what’s really important – enabling all Americans to obtain affordable, quality healthcare. 

We can now build on the significant advances already achieved under the act and truly transform our healthcare system. Because of this ruling, the ACA can be fully implemented to help reach the American Heart Association’s 2020 goal to improve the cardiovascular health of all Americans and, more immediately, prevent 1 million heart attacks and strokes over the next five years through the Million Hearts initiative. Under the law’s robust provisions, we are expanding access to preventive care and medicines to reduce an individual’s risk factors; placing a stronger emphasis on community prevention and wellness; and providing access to the care patients need to recover after a heart attack or stroke so they can lead longer, more productive lives.  

For the 122 million Americans with pre-existing conditions, including the 7.3 million with some form of heart disease or stroke who are uninsured, this decision will likely be met with a great sigh of relief. No longer will they be denied coverage or charged higher premiums because of their health status. Beginning in 2014, these Americans will finally be able to attain the lifesaving care they desperately need at a price they can afford.  

The ACA has also placed an extraordinary emphasis on the one thing that can ultimately conquer heart disease and stroke – prevention. For individuals, the law will continue to provide screening services that help keep risk factors such as high blood pressure, cholesterol, obesity and tobacco use in check. At the state and community levels, the Prevention and Public Health Trust Fund will continue to provide the tools and resources Americans require to eat better, be more physically active and live tobacco-free.  

Each and every one of us will need healthcare at some point in our lives. With this momentous decision, the Supreme Court has ensured that when we are patients, we can focus on our healing and recovery, instead of worrying about whether we can obtain or afford the quality care we all deserve.”  

Statement by Competitive Enterprise Institute Senior Fellow Gregory Conko

In enacting the healthcare individual purchase mandate, Congress and President Obama insisted that the measure was not a tax. Unfortunately, the Supreme Court refused to take them at their word. But at least the Court did not uphold the mandate as a legitimate exercise of Congress’s power to regulate commerce. Doing so would have granted government essentially unlimited authority over every aspect of the lives of Americans.

But the decision to uphold the mandate as a tax is troubling, like the Court’s prior commerce clause jurisprudence. Under the so-called “Rational Basis Test,” the Court has refused to question due process or equal protection violations when Congress’s reason for enacting the law might be “rationally related” to a legitimate government interest. Under that test, however, Congress does not have to explain why the law was “rational” as long as the Supreme Court can substitute its own rationale. Today’s decision says Congress does not need to call a regulation a tax—Congress and the President can even insist it is not a tax—if the Supreme Court can rationalize it as one: the Rational Tax Test.

Today’s decision gives ObamaCare a temporary reprieve. But an overwhelming majority of Americans have made clear that they do not want this healthcare law. Two years ago, then-House Speaker Nancy Pelosi insisted that Congress had to “pass the bill so that you can find out what is in it.” Well, Americans have now seen what’s in ObamaCare, and they want to see it repealed and replaced.

It was a dereliction of duty for the Supreme Court to uphold the individual purchase mandate. But eliminating the mandate alone would not have been enough. ObamaCare has been called a “government takeover” of American health care. But the sad truth is that, even before ObamaCare, federal and state government programs were already in direct control of close to half of all U.S. health care spending. In addition, private health insurance has for decades been subject to extensive state and federal regulation governing who must be covered and how.

In a very meaningful sense, government took over healthcare long ago. That has to change if health care reform is to be successful. The core problems in America’s healthcare system – high and rising prices, lack of consistent and reliable access for millions, rampant cost shifting, and an inability to distinguish between effective and ineffective services or between high and low quality, to name just a few – stem primarily from existing government interventions in the market for healthcare and health insurance. It will take more than some minor tweaks to repair America’s health care system, and returning to the status quo won’t be enough. Congress should now commit to a major overhaul that will cure the system’s endemic flaws.

Real reform will require dismantling the layers of overlapping regulatory fixes imposed from Washington over the past decades. In addition to streamlining entitlement programs, Congress should eliminate the tax disincentives that push individuals into employment-based insurance, scrap federal and state rules that dictate health plan design, open up competition among health care providers across state lines, and put more purchasing power in the hands of individuals.

Statement from Tennessee Health Care Campaign (THCC) 

The United States Supreme Court released this morning their much-anticipated decision on the constitutionality of provisions of the Patient Protection and Affordable Care Act, sometimes known as "Obamacare" or the Affordable Care Act. In this unprecendented ruling, the court found the individual mandate provision constitutional and upheld the rest of the law. The mandate would require all Americans to carry some sort of health insurance coverage or pay a tax penalty.

Tennesseans across the state are celebrating the Supreme Court decision upholding the Patient Protection and Affordable Care Act, rallying in communities across the state to show support for the healthcare reform law that will provide affordable access to high-quality healthcare for one million uninsured Tennesseans and guarantee protections to all 6.4 million state residents.

"With this landmark decision, the Supreme Court of the United States has marked the end of partisan political games to block implementation of the Affordable Care Act. There are no more excuses for delay. The Patient Protection and Affordable Care Act is the law of the land, and it is time for state lawmakers to start taking responsibility for ensuring that Tennessee families have the rights and protections guaranteed to them by the law," states Beth Uselton, Executive Director of the Tennessee Health Care Campaign.

The Affordable Care Act was already working for Tennesseans in a number of ways.

  • 82,000 people with Medicare received a 50% discount on their brand-name prescription drugs, saving an average of $590 per person. 
  • 797,000 people with Medicare received free preventive services - such as mammograms, colonoscopies - or a free annual wellness visit. 
  • 878 previously uninsured Tennesseans now have coverage through the new Pre-Existing Condition Insurance Plan
  • $15.1 million in grants from the Prevention and Public Health Fund to ensure that all Tennesseans can lead longer, more productive lives. 
  • $46.7 million to create and sustain new and existing community health centers to expand preventive and primary health care services in medically underserved area. 
This decision gives hope and peace of mind for millions of Tennessee families. Children can no longer be denied coverage because of a pre-existing conditions; insurers can no longer drop policyholders' plans, restrict benefits or place dollar limits on a person's coverage; small businesses will no longer be priced out of the market, and seniors will continue to have access to no-cost preventive services, vaccinations, and check-ups. 
"With all of these benefits and many, many more, Tennesseans will now be able to engage in a system that practices health care and not just sick care," states Director of Communications, Brad Palmertree. "We urge Tennessee lawmakers and policy makers to focus their future efforts on implementation strategies that puts consumers in control of their own care and provides guaranteed, affordable coverage for all. The cost of doing nothing is much too high."

Statement from Tom Van Coverden, President and CEO National Association of Community Health Centers (NACHC)

The U.S. Supreme Court today announced its decision on the Affordable Care Act (ACA). By upholding the constitutionality of the health reform law, the Court has assured that millions of currently-uninsured Americans will have the opportunity to gain insurance coverage over the next few years and that consumers will have vital protections and benefits under the law.   
The overall ruling will allow most of the ACA to proceed to full implementation. We are especially pleased that the Court’s decision reaffirms support for expanding access to healthcare through the nationwide network of Community Health Centers to more people in more communities across America. This means that in the years ahead millions of newly insured people, and communities identified as medical shortage areas, will gain access to doctors, nurses and other health care professionals, and the quality, cost-effective primary and preventive services our health centers provide.
The only disappointment in the ruling for health centers and the patients they serve is the weakening of the Medicaid expansion. This potentially leaves some of the 16 million eligible low-income people with no affordable coverage alternative, and it possibly denies many of these hard-working Americans the security of having insurance for their healthcare needs, no matter how complex or serious they may be.  
Nevertheless, now it is time to prepare for full implementation of the health reform law. Most of the 16 million people who hopefully will gain coverage under Medicaid expansion in 2014, and many of the additional 16 million people who will be able to purchase coverage through the new state Health Insurance Exchanges, live and work in the same communities that health centers serve. As healthcare advocates, Community Health Centers will have a major role in creating public awareness and understanding of the law’s benefits and protections, and in helping community residents who qualify to enroll with their Medicaid agencies or the Exchanges so that they are able to gain access to health care that all people need and deserve.

Brentwood-based MDSave Weighs In on ACA Winners & Losers

MDSave, a consumer-driven healthcare technology company based in Brentwood, weighed in with their take on the day's winners and losers in the Supreme Court decision. For more information, go to 

Statement from Dan Hogan, President & CEO of Medalogix

According to a study by the Center for Medicare & Medicaid Services, about 3.2 million Medicare patients were cared for by home health agencies in 2008. Twenty-nine percent were readmitted to the hospital. A reduction of hospital readmission rates by just 2% in home care alone, would help 928,000 people avoid rehospitalization and save upwards of $500 million.
This decision ends the guessing game for the healthcare community.  Hospital systems will definitively face reduced payments for services and other penalties if their patients are readmitted.  That reality is an absolute precursor to similar “pay for performance” modifications we will undoubtedly see in other healthcare sectors like the post acute services. 
As for the immediate effect of this morning’s decision, I anticipate a surge in healthcare facilities seeking a solution to meeting the Affordable Care Act’s requirements. Many organizations were putting off preparations to shift to these new parameters. Now they will be rushing to find an answer that addresses readmission concerns by October.   Truthfully, as Medalogix’s core competency is defining that risk for hospitals, home care agencies and skilled nursingfacilities, this decision is likely to help our business.

Nashville-based Medalogix deploys a medication-centric predictive modeling toolset to help hospitals, home care agencies and skilled nursing facilities reduce their rate of readmissions and unplanned hospitalizations. 

 COSE Reacts to Supreme Court Upholding Affordable Care Act

The Council of Smaller Enterprises (COSE) has released the following statement on the heels of today’s Supreme Court ruling upholding the Affordable Care Act (Healthcare Reform).  

“Our members share opinions on both sides of this law, depending on their size and their personal situation. As an organization, our focus has been to direct attention to the need to reduce the cost of health care, the inclusion of more people in the health care system, the creation of a widely available and accessible basic benefit plan, and the connection of consumer behavior and availability of information to decision making in health care. The ruling by the Supreme Court today addresses some of these issues.

With nearly 40 years of experience in small business health care, COSE understands the challenges small businesses face accessing insurance.  The law works to address this issue, which is a step forward.  However, true progress can only be made if we address the cost of care and the resulting cost of health insurance to small businesses and their employees. Now that we have a clearer direction, COSE looks forward to continuing its advocacy efforts and acting as a voice and resource for small business.”