"It's really not melodramatic to say that lives are going to be profoundly affected for the better," said Dr. Daniel Baxter, top medical officer for the William F. Ryan Community Health Network. "This means that children are going to be able to get their immunizations, women are going to be able to get appropriate cancer screening, people with diabetes are going to be treated."
In April, Gov. Andrew Cuomo issued an executive order to establish a statewide exchange starting in 2014, a marketplace where individuals and small businesses could tap into as much as $2.6 billion in federal tax credits and subsidies under the overhaul law. It is meant to insure every American, mainly those who don't have employer health plans or don't qualify for Medicaid. The U.S. Supreme Court upheld the overhaul's main provisions Thursday.
Cuomo on Thursday praised the ruling and Obama's leadership for measures that will provide access to health care for more than a million New Yorkers. His administration will keep moving forward with implementing the exchange, which also will lower coverage costs for businesses, he said.
Outside the Capitol, two dozen advocates from Health Care For All New York rallied. Organizer Bob Cohen called the promised coverage "basic economic security" people need to survive in a tough economy.
Right now, between 20 to 30 percent of the Ryan Network's patients are uninsured, Baxter said. Not all are poor. In these lean economic times, Baxter said he has seen a growing number of patients who have lost their private health insurance when they lost good-paying jobs.
The uninsured still get care, he said, but many patients often forgo treatment or precautionary measures rather than risk getting a big bill. One uninsured patient skipped a recommended X-ray a year ago because she didn't have insurance. As a result, Baxter said, it took an extra year for doctors to discover that she had cancer.
The law will also be a financial boon for places like the Ryan Network. Baxter said the health centers have long received some government reimbursement for treating the uninsured, but he said it has never been close to covering costs. "Had the law been overturned, many community health centers would find their viability in jeopardy," he said.
In Buffalo, Liz and Tim Evans have health insurance now through Liz's employer, Medaille College, but have gone without it for periods of years while employed part-time. At nearly $1,000 a month, it was too expensive. "I didn't really know how I felt about (the law) until the ruling. I was relieved and pleased it was upheld," Liz Evans said.
"I'm glad my daughter is going to be covered until she's 26," said Evans, a college librarian whose daughter is 12. "We've been in the position before of having pre-existing conditions and having to wait for coverage so I'm glad that's gone."
Evans has a thyroid condition, and her husband, a laid-off carpenter, has diabetes.
State Attorney General Eric Schneiderman said his office stands ready to enforce the law to ensure New Yorkers benefit from its protections, calling the court's decision a "historic victory" for millions of Americans.
"This law will continue to provide a spectrum of key consumer protections including keeping young adults on their parents' plans, ending pre-existing condition restrictions and increasing consumer information about health care choices," he said.
Under Cuomo's order, issued after legislation to establish the exchange stalled in the Republican-controlled state Senate, health officials plan to show by January that the state is ready to participate in the federal program. The goal is to have the exchange operating on Jan. 1, 2014, Health Department spokesman Peter Constantakes said.
New York has about 11 million residents who are insured, mainly through employer health plans, and 5 million low-income residents enrolled in Medicaid. Census data from last year showed nearly 2.9 million New York residents, or about 15 percent, without insurance, although the state estimate is 2.7 million — mainly working poor who don't have employer-sponsored coverage and Medicaid-eligible residents who haven't registered.
The Business Council of New York State said employers already struggle with high coverage costs, taxes and surcharges, and the Supreme Court's ruling does nothing to "bend the cost curve." The group said it will work to assure the exchange has full participation by insurers, agents, brokers, chambers of commerce and employers in all stages of development for "as robust a health insurance market and health care delivery system as possible."
An assortment of tax increases, health industry fees and Medicare cuts are supposed to pay for the changes. Starting in 2014, almost everyone will be required to be insured, with some exceptions, or pay a yearly fine. That would be $695 per person up to $2,085 per household, or 2.5 percent of household income, whichever is greater.
"We disagree with the Supreme Court's decision to affirm a massive tax increase that people cannot afford right now," said Scott Reif, spokesman for the Senate Republican Conference.
Associated Press writer Carolyn Thompson in Buffalo contributed to this report.