KANSAS CITY, MO (KCTV) -
It's a ruling the whole country was waiting to hear - the Supreme Court Thursday upheld the requirement that every American has to have health insurance or pay a penalty.
Millions of Americans will be eligible for subsidies to help pay premiums starting in 2014. It requires companies to provide coverage to people with pre-existing conditions.
KCTV5 has been gathering information to find out what the ruling means to people in Kansas City.
The ruling also impacts clinics, such as many around the metro, that cater to uninsured residents and Medicaid recipients.
Swope Health Services receives federal funds to provide medical care to thousands of low-income families at their clinics in Kansas and Missouri. No one is turned away.
"From the health industry perspective, it still adds uncertainty. We have a lot of policies in place, but not a lot of rules on how to implement the policies which have to clarified," Swope Health Services CEO Frank Ellis said.
Ellis, who is in charge of 11 Swope Health Services, said they serve patients with physical, mental and dental care and more than 90 percent of their patients live below the poverty level. Ellis is pleased that more people will now be insured.
"It's an opportunity for us - we are pleasantly surprised. It's an opportunity for us to grow in areas where we have history in improving patients outcome for some of the most difficult and vulnerable citizens in our area," Ellis said.
The Supreme Court ruling allows Medicaid, which provides health care to the poor, to be expanded, but the law can't require states to expand their Medicaid.
With Kansas and Missouri facing budget shortfalls, Ellis said the concern now is whether or not the states will opt in to pay their portion to cover the newly eligible people for Medicaid.
"What it does do, it does make uncertain the roads of reimbursement of the benefit packages are going to be for that population on a state-by-state basis and we are in two states right now, both Missouri and Kansas. So it still clouds the future in respect to what direction the two states will go," he said.
A lot of employees of small businesses could soon have a big decision to make in regards to insurance.
The wait staff at Gram & Dun on The Plaza works hard. They take orders and run tables for an hourly wage and tips and, currently, they don't get health benefits. The decision to uphold the health care bill changes that, but the restaurant's owner said employees may not win out.
"Would they like to have insurance? Absolutely. Can they afford it? That's really the big problem," Alan Gaylin, owner of Bread and Butter Concepts, said.
Under the health care law, if a company makes workers pay premiums higher than 9.5 percent of their household income, that's deemed unaffordable and could cost the employer a penalty.
But employers said it's hard to know what their workers' full household income is.
"It's bad for them, it's bad for us as a small business," Gaylin said.
If businesses don't provide coverage altogether, they'll owe a penalty of $2,000 per full-time worker.
"We can easily go, ‘everybody's on 32 hours a week, nobody's going to qualify for that.' I mean, that's certainly putting the employee in an even a worse situation," Gaylin said.
Additionally, businesses with fewer than 50 workers are exempt from the ruling, so companies could choose to lay people off. And the restaurant industry already has a low profit margin with lots of overhead costs.
"Somewhere along the line with the cost of rising fuel, rising food and beverage costs, we have to pass that along to the consumer," Gaylin said.
People in the restaurant industry worry another chunk from the bottom line could be too much for some, causing some businesses to fold.
The ruling will have a major impact on those without insurance, either because they can't afford it or don't want it.
Karl Keltner is a runner. He chooses to eat right, live healthy and he chooses not to have insurance.
"I don't want to pay for it, I'm healthy. I'm 50 years old and haven't been to the doctor in years," Keltner said.
Now, he's angry to have his choice taken away.
"To force me to purchase something that I don't want or need, I could go on and on about the implications of that and how it's breaching my freedom," Keltner said.
He said if he ever did end up in the emergency room, he'd find a way to pay, keeping the burden off the taxpayers.
"I may not pay 10 grand that day, but I'm going to pay what I can when I can, and if people did that, we wouldn't have the big problem that we have," Keltner said.
But hard at work at the Oasis Salon, Alisa Williams said Keltner's philosophy doesn't always work.
"Step in my shoes for one day," she said.
Williams learned how much she needed insurance when her husband got sick with brain cancer.
"It was unexpected, he'd never been sick, everything was covered," she said.
But, when her husband died, Williams lost her health care coverage too and couldn't afford to pay for it herself for long. Under the approved health care plan, lower-income and middle-class families will be eligible for subsidies to help pay their premiums, starting in 2014.
"That would be great for me," she said. "You need help certain times and this is a time that everybody is needing help."
Williams also said she is excited for another portion of the approved ruling Thursday that covers her 23-year-old daughters, who have had some health problems, up until the age of 26.
The ruling also means insurance companies cannot deny coverage to anyone with a pre-existing health condition, but not all of those people are welcoming the decision.
"It's called spondylolisthesis and it's actually the vertebrae slipping apart," said Jonathan Dine, who is uninsured.
Dine looks very healthy on the outside but, on the inside, he showed KCTV5 an x-ray of his spine that is sliding apart, leaving him in constant pain.
"What happens with my leg is it'll actually start to go numb and my feet tingle. And I have to sit down after standing for even 15 to 20 minutes at a time. So I find myself leaning over a lot to alleviate some of the pain," he said.
Dine is self-employed as a personal trainer and buying insurance with his pre-existing condition is a challenge. He only found two insurance companies that would cover him, but the cost was far more than he could afford.
"Both were wanting upwards of $800 to $900 a month. I am a single dad working part time so it's an impossibility to be able to afford that," he said.
And Dine is worried that, under the new health care law, he will be forced to buy insurance he can't afford, or face a tax.
But University of Missouri - Kansas City Law Professor Allen Rostron said in 2014 when the new health care plan goes into effect, those with pre-existing conditions should be able to buy insurance that is much more affordable.
"You don't get charged based on what your health is, whether you're healthy or you already have a pre-existing health problem. You just get charged based on where you live and those sorts of factors," Rostron said.
But Dine, who needs to have surgery to fix his back, is still worried that under the new health care law he can only buy insurance from the state he lives in, limiting his options.
"I would like to shop around, across state lines, and get a quote to buy it at a reasonable cost," he said.
It is clear that Thursday's ruling may not be the final word on this subject. The law requiring nearly everyone to have health insurance takes effect in 2014. The requirement for states to establish insurance exchanges starts Nov. 16. But the outcome on election day, Nov. 6, could determine what happens next.
Copyright 2012 KCTV (Meredith Corp.) All rights reserved.
