WASHINGTON – It has too much momentum for one judge to stop it.
Most insurers, hospital executives and state officials expect they'll keep carrying out President Barack Obama's health care overhaul even after a federal judge cast its fate in doubt by declaring all of it unconstitutional.
"It's still the law of the land," said William Hoagland, vice president for public policy at health insurer Cigna. "We'll continue to proceed with its requirements, and (the ruling) will not slow that down. We have no other choice until this thing is resolved one way or the other." Insurers spent millions to block passage of the law.
Health care accounts for about one-sixth of the economy, and many players in the sprawling sector have a love-hate relationship with Obama's health care remake. There's dissatisfaction with key provisions, and a sense that parts may be unworkable. But at the same time, it's seen as a vehicle to start addressing problems of cost and quality that, left to fester, could trigger more drastic consequences.
"I don't think people are going to hit the stop button," said Paul Keckley, executive director of the Deloitte Center for Health Solutions, a research arm of the consulting firm. "You probably don't make the big bets right now, but you make the incremental investments in case you have to make the big bets 6 or 12 or 18 months down the road. Everyone proceeds with an informed approach."
Monday's ruling by U.S. District Judge Roger Vinson in Florida had been expected to go against the Obama administration. But the scope of the decision in a lawsuit by 26 of the 50 states took some by surprise.
Vinson struck down the entire law after finding its requirement for nearly all Americans to carry health insurance unconstitutional. Another judge who reached the same conclusion in a separate case voided the individual insurance requirement and left everything else in place.
The administration plans to appeal both rulings. Meanwhile, judges in two other cases have upheld the law. It's generally expected that the U.S. Supreme Court will get the last word, but that could take another year or two.
During that time, thousands of pages of federal regulations that affect hospitals, doctors, states, insurers and others will be written. Among the issues are new models for hospitals and medical practices to band together, and new rules for operating the state insurance markets called for in the law. It adds up to thousands of jobs and tens of millions of dollars.
Florida Republican Gov. Rick Scott said Tuesday he plans to put the brakes on the state's role in implementing the law, but other players don't feel that states can afford to sit on the sidelines.
"The ruling does not change the urgent need for state-based reforms, nor should it derail efforts in the states targeted at fixing a broken and unsustainable system," said Alabama state Rep. Greg Wren. A Republican who says he agrees that the law is unconstitutional, Wren is nonetheless helping to lead a national task force on implementing it.
Presuming that the Supreme Court will ultimately rule against the law "is too risky a strategy," said Wren. For example, if states don't act, the federal Health and Human Services Department could step in to run new insurance markets in their backyards.
No interest group is in as dicey a position as the insurance industry. After trying to block passage of the law, it may end up having to defend its core requirement that people must get coverage. That's because the law also forbids insurers from turning away people with pre-existing medical conditions. Unless there's a way to force healthy people into the pool, the insurance system would be thrown out of balance.
Without the mandate that the judge in Florida ruled unconstitutional, "it's a house of cards," said Cigna's Hoagland.
Associated Press writer Bill Kaczor in Tallahassee contributed to this report.
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