“It’s full speed ahead with health care reform in Oregon regardless (of the court’s decision),” said Tim Raphael, a spokesman for Oregon Gov. John Kitzhaber.

The state already is recognized as a leader in reform efforts because of its plan of “coordinated care organizations,” networks that bring together different types of medical providers, including hospitals, to treat Medicaid patients in local areas. The first CCOs are expected to launch in August.

State officials consider that one of several steps they have taken to prepare for full implementation of the federal Patient Protection and Affordable Care Act in 2014. The law is designed to expand health insurance coverage to more Americans and control costs throughout the system.

But it might not make it to 2014.

Before its current term comes to a close at the end of the month, the Supreme Court is expected to rule on the constitutionality of the Affordable Care Act.

And the tone of the justices’ questions during oral arguments in March left pundits and court watchers expecting the law to be struck down either in part or in full.

The stakes for Oregon include significant new Medicaid funding that would start in 2014.

The health care reform law increases Medicaid coverage to individuals and families up to 133 percent of the federal poverty level. But the federal government pays for most of it, in fact all of it for the first three years, 2014-16.

It could mean coverage for another 300,000 to 400,000 Oregonians, according to the Kaiser Family Foundation.

The Oregon Health Authority said 14.6 percent of state residents lack health insurance.

In addition, Oregon has passed laws to implement consumer protections of the Affordable Care Act and to set up an insurance exchange — a market through which insurance companies will compete to offer health coverage beginning in 2014.

If the court throws out the whole law, “it’s going to be absolute chaos,” said U.S. Rep. Kurt Schrader, D-Canby. “The biggest consequence I see is premium increases.”

But conservatives say the expansion of Medicaid and other aspects of the law are ones the nation can ill afford when the national debt is close to $16 trillion.

The cost of the Affordable Care Act, according to the Congressional Budget Office, is $1.76 trillion for 2012-22.

“Is this really the best way to take care of the most vulnerable?” said John Graham of the Pacific Research Institute, a free-market think tank in San Francisco.

“This is just too much federal money. That offends a lot of people.”

The central issue before the Supreme Court is the Affordable Care Act’s mandate that requires people to buy health insurance or pay a penalty.

Is it constitutional? And if not, does the court have to invalidate the entire 2,700-page law?

Oregon officials answer no.

In a friend-of-the-court brief filed with 12 other states, including California and Washington, then-Oregon Attorney General John Kroger argues that before it strikes down the whole law, the court should consider the time and effort many states have already put into implementing various parts.

“Wholesale invalidation of the ACA (Affordable Care Act) would upend these decisions, waste unquantifiable resources, and wreak havoc on states, local governments and private citizens across the country,” the brief argues.

“States, for instance, have budgeted for anticipated grants, entered into contracts with private individuals, and overhauled their health care regulations, all in reliance on provisions that are completely independent of the minimum coverage provision.”

Joining the three West Coast states in these arguments are Iowa, Delaware, Connecticut, Hawaii, Illinois, New York, Vermont, the District of Columbia, Maryland and New Mexico.

And in a separate brief about the individual mandate question, Oregon, joined by many of the same states, argues its constitutionality is firmly rooted in the right of the federal government to regulate interstate commerce.

No one, they contend, can argue that a sector of the economy as big as health care — 17 percent of gross domestic product — is “somehow local in scope, or effect.”

They add: “Nor can one seriously argue that requiring most Americans to obtain a minimum level of health insurance coverage — through their employers, through a state benefit exchange, or through a state Medicaid program — unduly encroaches on state authority or state prerogatives.”

But Graham said the United States needs a system that encourages more efficiency and price competition. And the best way to do it, he said, is by getting away from group health plans and making people more responsible for their health care costs.

Source: http://www.statesmanjournal.com/article/20120621/NEWS/306210025/Oregon-officials-worried-about-health-care-roll-back?nclick_check=1