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very far-reaching.”Jodi Mitchell, execu-

tive director of KentuckyVoices for Health, a coali-tion of health advocacygroups, said her organiza-tion takes no position onthe arguments before theSupreme Court, insteadconcentrating on educat-ing the public abouthealth reform. But sheadded: “We expect thelaw will be upheld.”

One of the most well-known provisions of theAffordable Care Act, asthe reform law is called,requires insurers that of-fer coverage to childrenon their parents’ plans tomake that coverage avail-able until the child is 26.

That portion of the lawtook effect in September2010. According to theU.S. Department ofHealth & Human Ser-vices, 35,610 young Ken-tuckians already havegained coverage throughthat provision. In Indiana,38,480 young adultsgained coverage.

“This is helpful for col-lege students going toschool who can’t affordcoverage,” Mitchell said.“And because they’regenerally healthy, they’readvantageous on planswhere you’re trying tospread out the risk.”

This week’s argu-ments before the Su-preme Court won’t in-volve that provision, norseveral others of thebroad-ranging law, but in-stead will focus on a keyand controversial provi-sion — requiring nearlyall Americans to havehealth insurance by 2014.

According to the U.S.Census Bureau, an aver-age of 15.5 percent ofKentuckians — or 663,000people —lacked health in-surance from 2008-2010,as did12.8 percent of Hoo-siers, or 813,000 people.Nationally,15.8 percent ofAmericans lacked healthinsurance during that pe-riod.

Health care expertssay the reform law even-tually would bring therate of uninsured Ameri-cans down by about 60percent.

Louisville-based Hu-mana Inc., one of the na-tion’s largesthealth insur-ers, said it has long sup-ported universal healthcoverage for all Ameri-cans.

And the company saidthat other parts of the re-form law, such as requir-ing insurers to cover allapplicants regardless oftheir health condition,cannot work without the“individual mandate”provision. Otherwise,healthy people could passup insurance while sickerpeople would get it, rais-ing premiums for all.

Officials at local hospi-tal systems, which pro-vide charity care formany uninsured patientsand have unpaid billsfrom others, have saidprojections of how manypeople would gain cover-age under the reform laware encouraging.

But they add a caveat— saying it’s unclear ifprojected gains in pa-tients who would get in-surance under health re-form would be offset byfunding reductions in astate and federal pro-gram for hospitals thattreat large numbers oflow-income people.

Officials at UniversityHospital, which cares forlarge numbers of unin-sured patients, talkedabout this uncertaintyduring the debate involv-ing the proposed mergerwith Jewish Hospital & St.Mary’s HealthCare andLexington-based St. Jo-seph Health System,which is part of CatholicHealth Initiatives of Den-ver. Gov. Steve Beshearultimately rejected the

proposed three-waymerger, and Jewish andSt. Joseph merged with-out University to createKentuckyOne Health.

Officials at thosehealth care organizations— as well as others suchas Norton and BaptistHospital East — have saidthe reform law encour-ages them to partner withothers to become more ef-ficient, improve care andreduce costs.

Norton and UK lead-ers said the law is one ofthe main reasons behindtheir partnership, an-nounced in June. Thatpartnership includes astatewide stroke collabo-ration and a cancer pro-gram that would share re-sources.

Norton and Humanaare also piloting an “ac-countable care organiza-tion” for commerciallyinsured patients, a pro-gram that establishes fi-nancial incentives forhealth care providers toimprove quality, elimi-nate waste and controlcosts. Louisville is one offour national sites in theACO Pilot Project of TheEngelberg Center forHealth Care Reform atthe Brookings Institutionand The Dartmouth Insti-tute for Health Policy andClinical Practice. Offi-cials said the programbrings a emphasis onwellness and preventivecare for patients.

Last October, the U.S.Centers for Medicare &Medicaid Services final-ized new rules under thehealth reform law to helpdoctors and hospitals bet-ter coordinate care forMedicare patientsthrough ACOs. The Medi-care program is designedto reward ACOs that low-er the growth of healthcare costs while still pro-viding quality care.

Williams said Nortonwill still go forward withthe ACO and partnershipsno matter what happenswith the health reformlaw.

“Even if major parts ofit get repealed, I believewhat we are doing andwhat other providers aredoing we will continue todo,” he said. With healthcare expenditures mak-ing up 18 percent of theGross Domestic Productin the United States, “wehave to bend the costcurve or we are going tocripple the economy.”

Reporter Laura Ungar canbe reached at (502) 582-7190. Reporter PatrickHowington contributed tothis story.

REFORM: Region keepsclose watch on actionsContinued from Page A1 REFORM LAW’S

EFFECT» In 2014, most Americanswould be required to havehealth coverage. That couldmean that up to 663,000uninsured Kentuckians and813,000 Hoosiers wouldobtain coverage, based onCensus data. However, onesubject before the SupremeCourt is whether this “indi-vidual mandate” is constitu-tional.» Last year as a result of thereform law, 74,913 Ken-tucky seniors and 89,096Indiana seniors got a 50percent discount on brand-name prescription drugsonce they hit the “dough-nut hole” gap in Medicaredrug coverage, the federalgovernment said.» 732,000 Kentuckians and1.16 million Hoosiers withprivate health insurancegained coverage for pre-ventive services with noco-payments last year be-cause of the law, accordingto the Department ofHealth & Human Services.» 435 Kentuckians and 678Hoosiers who had not beenable to get health insurancebecause of a pre-existingmedical condition obtainedcoverage through specialgovernment-run healthplans for such people.

Today’s arguments willfocus on the heart of thecase, the provision that aimsto extend medical insuranceto 30 million more Ameri-cansbyrequiringalltocarryinsurance or pay a penalty.

A decision is expected bylate June as Obama fightsfor re-election. All of his Re-publicanchallengersopposethe law and have promisedits repeal if the high courthasn’t struck it down.

Monday,thejusticestookon the question of whetheran obscure tax law could de-rail the case. The19th centu-ry law bars tax disputesfrom being heard in thecourts before the taxes havebeen paid.

Under the new healthcare law, Americans whodon’t purchase health insur-ance would have to reportthatomissionontheir taxre-turnsfor2014andwouldpaya penalty along with federalincometaxonreturnsduebyApril2015.Amongtheissuesfacing the court is whetherthat penalty is a tax.

Solicitor General DonaldVerrilli Jr., defending thehealthlaw,urgedthecourttofocus on what he called “theissues of great moment” atthe heart of the case. The 26states and a small businessgroup challenging the lawalso want the court to goahead and decide on its con-stitutionality without delay.

But one lower court thatheard the case, the federalappeals court in Richmond,Va., has said the challenge ispremature. No justiceseemed likely to buy that ar-gument Monday.

The justices fired twodozenquestionsinlessthanahalf-hour at Washington at-torney Robert Long, whowas defending the appealscourt ruling.

“What is the parade ofhorribles?” asked JusticeSoniaSotomayor,ifthecourtwere to decide the penaltieswerenotatax,andthehealthcare case went forward?

Long suggested that couldencourage more challengesto the long-standing systemin which the general rule isthat taxpayers must pay adisputedtaxbeforetheycango to court.

The questions came soquickly at times that the jus-tices interrupted each other.At one point, Justices RuthBader Ginsburg, Elena Ka-gan and Sotomayor startedspeaking at the same time.Chief Justice John Roberts,acting as traffic cop, sig-naled Ginsburg to go first,perhaps in a nod to her sen-iority.OnlyJusticeClarenceThomas, as is his custom,stayed out of the fray.

Verrilli also faced point-ed questioning about the ad-ministration’s differing ex-planations for whether thepenalty is a tax.

“General Verrilli, todayyouarearguingthatthepen-alty is not a tax. Tomorrowyouaregoingtobeback,andyou will be arguing that thepenalty is a tax,” JusticeSamuel Alito said.

Verrilli saidMonday’sar-gumentdealtwiththemean-ingofthewordinthecontextof the 19th century law, theAnti-Injunction Act. Tues-day’s session will exploreCongress’ power to imposethe insurance requirementand penalty. In that setting,hesaid,Congresshastheau-

thority under the Constitu-tion “to lay and collect tax-es,”includingthepenaltyfornot having insurance.

Still, he hadtrouble keep-ing his terms straight. An-swering a question from Ka-gan, Verrilli said: “If theypay the tax, then they are incompliance with the law.”

Justice Stephen Breyerjumpedin:“Whydoyoukeepsaying tax?”

BreyerremindedVerrillihe should be saying penalty.

“Right.That’sright,”Ver-rilli said.

Administration officialsinvolved with defense andimplementationofthelaw—AttorneyGeneralEricHold-er and Health and HumanServices Secretary Kath-leen Sebelius — were in thecourtroom Monday. Repub-lican Sen. Jeff Sessions ofAlabama and Florida Attor-ney General Pam Bondi alsowere in the crowd that filledthe courtroom’s 400 seats.

Outside the court build-ing, about 100 supporters ofthe law walked in a circleholding signs that read:“Protect my healthcare,”and chanting: “Care for you,care for me, care for everyfamily.” A half-dozen oppo-nents shouted: “We love theConstitution!”

Republican presidentialcandidate Rick Santorumwas there, too, declaring

anew that GOP front-runnerMitt Romney has no stand-ing to challenge Obama onthe law because Massachu-setts passed a somewhatsimilar version when Rom-ney was governor.

“If you really want Oba-macare repealed, there’sonly one person who canmake that happen,” Santo-rum said.

“If I’m elected president,I will repeal Obamacare.And I will stop it in its trackson day one. I believe it’s un-constitutional. I believe thecourt will find it unconstitu-tional,” Romney said onCNN.

A four-person studentband from Howard Univer-sitywaspartof thegroupfa-voring the law, playing NewOrleans-style jazz tunes.

People hoping for aglimpse of the action hadwaited in line all weekendfor the relatively few seatsopen to the public. The jus-tices allotted the case sixhours of argument time, themost since the mid-1960s.

Thejusticesalsowilltakeup whether the rest of thelawcanremaininplaceiftheinsurance mandate fallsand, separately, whetherCongress lacked the powerto expand the Medicaid pro-gramtocover15 millionlow-income people who current-ly earn too much to qualify.

If upheld, the law willforce dramatic changes inthe way insurance compa-nies do business, forbiddingthem from denying cover-age for pre-existing condi-tions and limiting what theycan charge older people.

Thelawenvisionsthat in-surers will be able to accom-modateolderandsickerpeo-ple without facing financialruin because of its most dis-puted element, the require-ment that Americans haveinsurance or pay a penalty.

By2019,about95percentof the country will havehealth insuranceif the lawisallowed to take full effect,the Congressional BudgetOffice estimates.

SUPREME: Court weighs health care argumentsContinued from Page A1

Today the U.S. Supreme Court will hear arguments aboutthe constitutionality of the health care law. GETTY IMAGES

Time: 03-26-2012 21:43 User: cdye PubDate: 03-27-2012 Zone: KY Edition: 1 Page Name: A 6 Color: CyanMagentaYellowBlack