Anniston nurse practitioner Chase Thomas did not know how the federal government’s health care reform law would affect the medical community when it passed in 2010.

He’d still like to know today.

The U.S. Supreme Court upheld the legality of the Affordable Care Act on Thursday — in particular a part of the law that mandates all Americans must purchase health insurance if they can afford it. However, to several local health care professionals, legal confirmation still does not answer questions of how the law will work and affect the medical industry.

“As far as increased access to care, I think it’s a good thing,” said Thomas, who owns Pediatrics Plus in Anniston. “But nobody knows yet what Medicaid reimbursements are going to be. Only time will tell.”

As part of the Affordable Care Act, which takes effect in 2014, the parameters of Medicaid and Medicare will be expanded, allowing more poor and disabled people coverage under the programs. According to the Kaiser Family Foundation, when Medicaid eligibility standards change in 2014, Alabama would cover 351,567 new enrollees and generate another $10.3 billion in federal funds for the health care industry here during the first five years. To generate the $10.3 billion, Alabama’s state government would need to contribute $470 million during the same five-year period. The Kaiser Family Foundation is a non-profit, non-partisan group that focuses on health care issues facing the country.

At the same time, however, reimbursements from Medicaid and Medicare to physicians and hospitals for the care they provide patients in those programs would be reduced. Meanwhile, the law calls for the creation of health insurance exchanges, marketplaces where people can purchase health insurance plans. The exchanges are designed to help those uninsured who make too much money to qualify for Medicare or Medicaid but still not enough to afford private health insurance.

Wary welcome from hospitals

Currently, 720,000 people in the state, or about 15.4 percent of Alabamians, are uninsured.

“Clearly we’re excited more people will have the ability to have more coverage,” said Barry Keel, CEO of Stringfellow Memorial Hospital in Anniston. “And ultimately, the good news is this ends the uncertainty that has surrounded the insurance mandate for a good while.”

Still, Keel was uncertain if the law would be helpful to his hospital in the long run in terms of lowering costs.

Currently, the cost to provide care to uninsured patients is stressing the budgets of hospitals across the country.

“Physicians will be paid less per patient to cover more patients,” Keel said. “It’s a give and take … it could end up being a … net-zero impact.”

Keel added that having more people covered by insurance could, in itself, help lower medical costs. If people have insurance, they might be more inclined to seek medical care before a condition or sickness becomes too serious and more costly to treat.

“Preventative care is very important to avoid major issues,” Keel said.

David McCormack, CEO of Regional Medical Center in Anniston, said he did not have a problem with the individual insurance mandate.

“I have to have insurance and you have to have insurance,” McCormack said. “And for our business here … we have tons of uninsured coming in here and it’s killing us.”

However, though he thought the individual mandate could help his hospital lower costs, McCormack suspects the law could raise costs in other ways.

“The law adds more regulations, departments … all that bureaucracy takes a lot of resources … we’ll have to work through that,” McCormack said.

In any case, Rosemary Blackmon, president of the Alabama Hospital Association, said her organization was glad the Supreme Court upheld the majority of the law and not just parts of it. If the court had struck down the mandate while leaving in the reduction of reimbursements to hospitals treating uninsured patients, for example, the result might have been disastrous, Blackmon said.

“If they had pulled out the mandate, it would have been hard on hospitals financially,” she said.

State reaction may be key

However, Jim Edmondson, CEO of Jacksonville Medical Center, said he was concerned about a section of the law that was not upheld — the provision that allowed the federal government to withhold Medicaid money from states that refuse to expand their Medicaid programs as required in the law. Cost-saving efforts may not work without the expansion, he said.

“That’s a concern going forward,” Edmondson said. “I’m anticipating the state Legislature won’t participate.”

Indeed, the Legislature has resisted the law, refusing to approve the creation of a health insurance exchange earlier this year.

In a Thursday email to The Star, Alabama Senate President Pro Tem Del Marsh, R-Anniston, stated his disapproval of the law and the Supreme Court decision.

“Today’s Supreme Court ruling confirms that Obamacare is in fact one of the biggest tax increases in our nation’s history,” Marsh wrote. “While the federal government increases bureaucracy and red tape that cripples small business, Alabama Republicans will continue fighting this intrusion by working to make state government more efficient and boost private-sector economic growth.”

Nancy King Dennis, director of public relations for the Alabama Retail Association, said her organization and many state retailers are concerned about how the law might affect costs to businesses.

“We’re very interested in this decision and what it means to the employer,” Dennis said. “Retailers are cautious about hiring until they know what the costs will be back to them from this. Right now, retailers need some more guidelines on what this means to them.”

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star