Dallas-Fort Worth Healthcare Execs, Physicians Weigh in on Supreme Court Decision

Earlier today, D Healthcare Daily Editor Steve Jacob offered his opinions on the impact of the Supreme Court’s decision to uphold the Affordable Care Act. Steve and assistant editor Jessica Melton have since checked in with healthcare executives and physicians across North Texas to get their reactions. Here’s their report:

Dallas-Fort Worth healthcare providers say the Supreme Court’s ruling offers a clearer path to what the healthcare landscape will be for the rest of the decade.

Doug Hawthorne, president and chief executive officer of Texas Health Resources, said the court’s decision lifts the “cloak of uncertainty. This gives clarity to the issue of insurance coverage. When people are uninsured or underinsured, they often wait too long to access the system. Then it becomes more expensive. The more this encourages people upfront to use the system, the better.”

W. Stephen Love, president and chief executive officer of the Dallas-Fort Worth Hospital Council, pointed out in a statement that more than 4 million Texans lack health insurance.  “(The law) is very important since Texas has a 27 percent uninsured population which is the highest in the nation. In the Dallas-Fort Worth area, the uninsured percentage is closer to 30 percent. Currently, 1.2 million Texas children have no medical insurance and approximately 40 percent of mothers do not receive appropriate pre-natal care.”

Joel Allison, president and chief executive officer of Baylor Healthcare System, said the ruling “validates the pathways we have put in place. We have been moving toward (the ACA mandates). This reinforces the opportunity to own, joint venture or partner (with others) to provide the full continuum of care, and connect all of that digitally.”

Erin Carlson, health policy professor at the University of North Texas Health Science Center, said she had faith that the Supreme Court would “come up with something no one expected and be fair. This (law) is life-changing for a lot of folks. Millions of people have been making life-altering decisions–having babies, marriage, divorce, holding onto jobs–simply because of health insurance. This (ruling) is huge.”

John McCracken, clinical professor of healthcare management at the University of Texas at Dallas, said he was surprised that the court ruled that states would not be penalized if they opted out of the ACA’s Medicaid expansion. “Nobody thought that the court would invalidate that, but they did. That’s going to have a huge impact on Texas (because of its opposition to the law,” he said.

Robert Earley is president of Fort Worth’s John Peter Smith (JPS), a public hospital that treats a significant number of uninsured patients. He said, “Texas has the highest number of uncompensated-care patients in the nation. Hopefully, state leaders will look at every opportunity to overcome that. And we hope they will focus on putting the patient first. The ruling keeps in place what we knew was out there and emphatically tells us these are the rules of the game. Certainly there is a political element to this. But for us (in healthcare), we see what’s coming and we’ve been planning for it for the past two years.”

Local physicians also believed the ruling provided clarity, but many said the law failed to address several of their concerns.

Rick Snyder, Dallas cardiologist and president of the Dallas County Medical Society, said, “Today’s health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients. As physicians, we are spending more and more time with paper than with patients.  We need to find what’s missing, keep what works, and fix what’s broken in the new law.”

Snyder said the law is too focused on protecting hospitals, pharmaceutical companies and medical device makers while neglecting what he predicts will be physician shortage “meltdown” because of insurance-coverage expansion.

Shelton Hopkins, Dallas orthopedic surgeon, said, “It’s a step in the right direction, especially symbolically. It says that we think all Americans deserve coverage, regardless of whether or not they can pay for it. A lot of physicians take care of patients with little or no payment. We will never finish working on our healthcare system. There isn’t a country in the world that is completely happy. There’s always tinkering, and we have some serious tinkering to do. ”

Christopher Crow, a family physician in Plano, said, ” This gives all of us–doctors, employers, patients and all America–some sense of certainty about the law so we can start preparing for its changes in 2014. As a family doctor, there are plenty of provisions that support primary care as the anchor of healthcare reform that I’m pleased will continue. (However), with an existing shortage of physicians in Texas it could delay the ability of patients to get in to see a doctor or worse overrun our emergency rooms with non-emergency problems.”

David Winter, president of HealthTexas Provider Network, which employs more than 500 physicians locally, also mentioned the likely burden of the newly insured on local physicians. “Who’s going to take care of them? Everyone is busy in North Texas. We are struggling to have enough primary-care physicians right now. This doesn’t solve the physician shortage. We are working hard on recruitment, training, and technology to provide more efficient and better distributed care.”

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  • ozonedude

    I appreciate your non-hysterical coverage of what the ruling really means in our daily lives.

  • Ultimately, the uninsured will still have no coverage…..and, now, we get to pay a penalty tax to the U.S government for not being able to afford insurance. All the uninsured will still abuse ER services and uncompensated care will still be an issue. I don’t see anything good about the individual mandate.

  • Eric

    Yes, I’m sure Dr. Snyder would spend more time per patient if there was no Obamacare or regulation. Or would he just stuff a few more patients in per hour? Or is he worried that better preventitive care might cut into his lucrative specialty down the road? If we keep what WORKS will that truly include Dr. Snyder?

  • Albert

    It’s going to save me a bundle. Presently I insure myself and my daughter, at a cost of 5% of my salary. The fine which is now a tax is only one percent of my salary.

    So, I’ll pay the fines yearly, and if either of us should require some expensive procedure or hospitalization, I can buy the insurance the day I get the diagnosis, then drop it after everything’s fixed.

    With my savings, I can spend more time fly fishing in Arkansas – sweet, sweet deal, thank you Commandante Obama!

  • towski

    Let us know how that works out for you, Albert.

  • Blaine

    The health care industry just became another cost-plus government utility like the defense industry, so now the $800 toilet seats that bloat the heal care industry can be paid directly from the U. S. Treasury with lower billing and administrative costs.

    On the brighter side, those regions who can attract and grow large clusters of these new nationally funded utilities will win the prize, because, unlike disputed military technology, paying whatever it takes to stay alive will always top any list of limited choices.

    Really, Congressman, you voted to curb physician reimbursements, the physician didn’t treat little Susie, and now little dead Susie’s sobbing parents are on Good Morning America? Really, Congressman? You should have posted your sexual frolic with that dead boy on your Facebook page instead.

  • Albert

    I just did, towski. I’m not the only one planning this, lots of people have done the math.

    Tis is predicated on the fine amounts remaining as described in the law, which goes up to I think 2.5% after 3 years – which is still half my present cost – and I haven’t used my insurance in 8 years, that’s about 18K into the ether, with no benefit.

    There is a possibility that the fines will “evolve”, but I still have wiggle room.

  • towski

    You haven’t used your insurance in 8 years, Albert? You have a daughter? You aren’t getting her, or yourself, preventive, maintenance care? Taking her to the doctor for well checkups?


  • Glenn Hunter

    @Towski: Just a bystander here, but is it really any of your business how Albert chooses to use his insurance or to care for his daughter?

  • towski

    Nope. Not at all. But this is a public comment section still, isn’t it Glenn? If Albert’s going to share the flaws he sees in the system, and let us know that, for him, it’s strictly an economic consideration, I’m within my rights to criticize that, aren’t I, since he chose to share?

    Look, I’m a brand new father, so maybe I’m a little sensitive to the whole situation. Maybe I’ll become more callous regarding my child’s well being once I have a second or third one.

    And you are hardly a bystander, are you Glenn?

  • Albert

    Towski, I don’t use insurance for check ups, and no-one has required hospitalization. You might do the same once you’ve raised three kids, your call.

    There are no holes in my math, only the unpredictability of evolution in DC.

  • towski

    Wow, I’m surprised. If you are spending 5% of your salary on insurance, why wouldn’t you use it for checkups? Maybe I’m missing something.

    I will say your post inspired some research on my part. The Massachusetts system has a similar hole, in terms of the choice to pay the fine and wait to become insured, but the state has had a surprisingly high enrollment rate.

    The fine for not carrying insurance wasn’t especially big: for 2007, $219 in 2007. Paying that penalty would have been significantly less expensive than buying a plan. Still, most Bay State residents have opted for the latter, more expensive option.

    “If people in Massachusetts were economists, they would have said I’m not going to comply,” Chandra said. “But they aren’t economists, and they hate the word penalty. I think Americans generally tend to be law-abiding people, and they hate the idea of not complying with a requirement.”

    “Massachusetts’ penalty for not carrying coverage has increased over the years; in 2012, it could be as high as $1,206 for an individual. Compliance has tended to be very high. In 2010, the most recent year for which data is available, fewer than 1 percent percent of 6.6 million residents – approximately 44,000 people – were assessed a penalty for not carrying coverage.”


  • Albert

    I can discuss the elements of my health plan in great detail if you’d like, towski. How higher deductibles mean lower cost and medical savings accounts help offset, stuff like that – but it’s boring. As a new dad (congratulations), you’ll be dealing with in time.

    As for Mass info you’ve posted, my math still works when applied to their plan. At $1,206 , I still come out ahead.

  • Blaine

    While liberal Village Voice columnist Roy Edroso admits Obamacare is not much more than “a dog’s breakfast of industry bribes”, he has “been enjoying the weeping of the wingnuts”.


    So, for a trillion dollars, it does have that going for it.

  • towski

    I’ll take your word for it, Albert. For me, with employer provided health care, it’s doubtful I’ll find myself in a comparable situation.

    And, frankly, good for you, if you have found a loophole that you think will benefit you both short and long term. As someone with a chronic condition (Type 1 Diabetes) that, without insurance, would require enormous outlays of cash on a monthly basis, I can’t imagine having to do without insurance for my family as part of a cost analysis. I don’t envy you the task.

    See, Glenn? We handled the discussion just find without your pithy input. Run back to covering whatever flamethrower is in town.

  • Albert

    In keeping with the democrat call for civil discourse in our politics, someone at the DNC tweeted this:

    “It’s constitutional. B*****es. TAKE THAT M******F***R!!”

    (I posted this at the Observer, and could use the actual words)

    BTW, I presented my money-saving scenario over there, with the experts, and it was explained to me that I it couldn’t work because I watch too much FOX news, am not very bright, and over 5,000 Americans have lost their lives in Iraq.

    Well, there goes my plan!

  • Albert

    Tax avoidance is the moral imperative of every good American.

  • towski

    I imagine that person is fired.

    That sucks about your plan though. If only you’d known.

  • Albert

    If I stop watching FOX, maybe my plan will work?

  • Glenn Hunter

    @towski: I’m very happy for you.

  • towski

    That seemed sincere.

  • km

    um, albert, you do realize that if you or a family member receive a diagnosis for a chronic condition/procedure while uninsured that you will be denied coverage, correct? when applying for insurance, you will have to disclose your health conditions – so, if you’ve received a diagnosis that day, you will have to disclose it and depending on the severity, the insurance company may deny coverage. health insurance is not like car insurance, you can’t just purchase it when you may need it. generally, when you really need it is when you will be denied coverage. that’s the whole struggle that so many with pre-existing conditions face.

  • beevis

    @km – I thought under the new plan that no one could be denied insurance due to a pre-existing condition. Let me know if I’m confused – which is always entirely possible.

  • km

    beevis – no, you’re correct, the ACA provides that insurance companies may no longer deny coverage based on a pre-existing condition. However, this part of the Act does not take effect until 2014. Currently, for those with pre-existing conditions, there are federal risk pools set up to fill the gap until 2014, but I believe that you have to go without insurance for six months in order to be eligible.

    I am the wife of a Type I diabetic, and our every move, particularly with respect to employment/career planning, is dictated by insurance coverage. I cried on Thursday because now someday my husband and I may be able to open up the small business we’ve always wanted to do, but never could because one of us had to be employed by someone else for him to have coverage (I live out of Texas now, and there’s no state risk pool where we are).