MDJ Staff/Laura Moon

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MARIETTA — Cobb citizens reacted swiftly Thursday to the Supreme Court’s 5-4 decision to uphold the provision of the Affordable Care Act of 2010 that requires most people to buy health insurance, or pay a tax.

Chief Justice John Roberts wrote for the majority but was accompanied by the court’s more liberal justices, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, and Elena Kagan.

Conservative justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito were in the minority.

Around Cobb, ruling reaction tended to fall along partisan lines. Conservatives like Attorney General Sam Olens, state Rep. Sharon Cooper, tea partier J.D. Van Brink and Libertarian David Chastain were furious, while more liberal-leaning leaders like Cobb Democrats chair Melissa Pike and state Rep. David Wilkerson were celebrating.

David Bottoms, the senior vice president of Marietta-based benefits consultants The Bottoms Group, read the entire legislation after it was approved by Congress and signed into law in 2010. The bottom line of Thursday’s landmark decision is that health care costs are going to continue to rise for everyone, he said.

The ruling, and the law itself, clearly helps people with pre-existing conditions, many of whom find insurance prohibitively expensive — if they can find it at all.

“There weren’t any options for them to get coverage. This definitely helps them,” Bottoms said. “Conversely, now that those people are in the market, average rates will go up for everybody, to offset the new risk.”

The law and its penalties could result in some smaller employers dropping insurance benefits for employees, leaving those people to buy their own individual policies.

As of Jan. 1, 2014, businesses with more than 50 employees will have to offer coverage or pay fines of $2,000 per employee per year. Health-coverage costs are tax deductible, but the fines are not, Bottoms said.

“When you consider what the average employer is contributing for coverage and contrast that with not offering coverage and paying the fine, you’ll have a lot of people do the math,” Bottoms said. “But employers who aggressively attract good employees will still be compelled to offer it as a benefit. Right now, there’s no legal requirement for employers to offer coverage, but many do.”

Bottoms also said insurers are helped by the ruling.

“Their worst-case scenario was if the mandate were struck down but they were still required to insure anyone, although I suspect they would have been just as happy if the whole thing went away, just because of the regulation that comes with it,” he said.

Still, Bottoms said the end result could make health insurers a thing of the past.

“I think 20 years from now, this bill will have gradually killed the insurance carriers. At that point, we’ll probably have universal government-provided coverage, which some people will love and some people will hate,” he said. “But there’s no question it will be expensive.”

Olens spent Thursday with likely GOP presidential nominee Mitt Romney — who Olens said raked in more than $2 million in online campaign donations on Thursday, after the decision was announced. Romney has said that on his first day as president, he would begin dismantling “Obamacare.”

Olens, who joined the legal challenge after taking office in 2011 and was in the courtroom for some of the oral arguments, also said he was stunned by the court’s decision.

“No one would have expected” Chief Justice Roberts to go with the tax clause on the individual mandate, Olens said, especially since even the White House had insisted that the penalty to be paid by Americans who didn’t buy insurance specifically is not a tax. Roberts ruled it is.

“The president is destroying the health care Americans have and replacing it with an inferior product,” Olens said. “Find me someone who would prefer to have Medicaid than Blue Cross/Blue Shield or Aetna. We used to complain that insurers were regulating care, but now it’s government bureaucrats regulating it.

“We can do better. We know there needs to be change, but we’re on a fiscal cliff,” he said.

The court’s ruling on expanding Medicaid — essentially, the court found that the federal government cannot yank all of a state’s Medicaid money if the state refuses to expand the coverage to more low-income people — is a win, Olens said.

“Unfortunately, that’s winning the battle but not the war,” he said.

Melissa Pike, chair of the Cobb Democratic Committee, sees the ruling differently.

“This is a victory for Americans, not just for Democrats,” she said of the ruling. “There are so many people whose lives literally depend on this ruling.”

State Rep. David Wilkerson, a south Cobb Democrat, does not believe expanding Medicaid coverage will bankrupt the state or the country. The federal government would pay for the expansion for a few years, under the law.

“I don’t think Georgia can afford to have 2 million people without health coverage,” he said. “It’s free money to the state of Georgia.”

As for overall costs of the law, he said: “If you believe the Congressional Budget Office when they say it will cost $1 trillion, you have to also believe them when they say it will reduce deficits.”

WellStar Health System CEO Reynold Jennings said he thinks Thursday’s decision means only large care providers will survive. WellStar has been buying up many doctors’ practices and putting those doctors on its payroll in recent years will continue that, he said.

As for implementation of the law, “the devil is in the details as to what we’ll be required to do when all 1,500 mandates are identified,” he said, adding that “anxious” was an apt way to describe his feelings.

In fiscal year 2011, the Marietta-based system received $380 million in Medicare revenue, and $124 million in Medicaid revenue, he said. Those programs pay about 80 percent of the actual cost to provide care.

In addition, WellStar provided $200 million worth of unreimbursed care in fiscal 2011.

“In the recession, many people are taking higher-deductible policies and can’t pay their bill at the time the service is rendered,” he said. “Twenty percent of people with insurance need a payment plan for their portion of the bill. We see that as a rising problem, even as other people get insurance.”

Like many, he pointed out that the law does not solve all of the nation’s healthcare problems.

“This law does nothing to change the way Medicare in its entirety is financed and handled,” Jennings said. “Over 100,000 people every month in the United States go onto Medicare. That financial deficit all by itself far overshadows the 20 million young people who generally use less health care but are now getting coverage.”

Jennings said doctors are wondering how they’ll stay open by providing Medicare and Medicaid care at a financial loss, coupled with smaller payments by insurers.

“Doctors are businesspeople and they have expenses,” he said. “They have to figure out a way to make a living.”

That is exactly what bothers state Rep. Sharon Cooper, a registered nurse who represents a portion of east Cobb.

“We are desperately short of physicians,” she said. “People don’t think about a physician’s office being a business, but they lose money on Medicaid. Then they lose money on Medicare. They pay their staff, they pay rent, they pay utilities. If they don’t have enough paying patients, they shut their doors.”

The most distressing impact of the health care law, she said, is that it interferes with the doctor-patient relationship.

“Whoever controls your health care controls your very life,” she said. “You can fight an insurance company, but let me tell you, you can’t fight the federal government and win.”

She is relieved the Obama administration lost on the Medicare expansion.

“Long-term, it’s not possible for us to expand Medicaid for that many people without a major tax increase,” she said. “We’re working on limited budgets just like families are.

“In a perfect world, everybody would be covered by insurance and have good health care. But this is not a perfect world,” Cooper said. “The state and the federal government only have so much money, and we’re fixing to bankrupt our nation.”

Dennis Kiley, chief executive of Emory-Adventist at Smyrna hospital, had a different take on the ruling.

The 88-bed hospital on South Cobb Drive is affiliated with the Seventh-Day Adventist Church and is operated by Adventist Health System as a joint venture with Emory Healthcare.

“We are pleased that the court has upheld the health care reform act and specifically the individual mandate,” Kiley said in a statement. “Without that provision, we believe that the other provisions such as elimination of pre-existing condition would become financially difficult to implement. We also believe that the uninsured problem would have continued to grow which would have put greater and greater pressure on hospitals to continue to subsidize care.

“We recognize that the health reform bill is not perfect, but it does much to lower the number of uninsured and to increase access to care,” he said. His hospital treated more than 25,000 patients in its emergency room last year.

David Chastain, secretary of the Cobb Libertarian Party, doesn’t like the law because it goes against the marketplace.

“We had a system that wasn’t working well, but it was kind of working,” he said. “Now it’s going to be even more restrictive and limited, and drive prices up.

“It boils down to this: are we a country that believes in individual liberty, or are we a country that believes in collectivism?” he said. “We have now become a collectivism country.”

J.D. Van Brink, chairman of the board of the Georgia Tea Party, said the passion of his members against government encroachment in individual lives is “at a new level” amid the decision.

“This is systematic of a lot of things the government is doing, and it’s not just the federal government or the executive branch of the federal government,” Van Brink said. “Governments in general are not following the Constitution.”

Katy Misel, 25, a Kennesaw State University graduate student, said she doesn’t like the overall law, though the provision that allows young people to stay on a parent’s insurance until age 26 is reasonable. But she is too independent to do that, she said.

“I certainly don’t think the government has the right to say you have to have health insurance,” Misel said.