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They may applaud or be appalled by the Supreme Court’s decision Thursday.

But area business owners say its ruling that the Patient Protection and Affordable Care Act is constitutional doesn’t end confusion and uncertainty over the act itself.

“I think the political questions remain,” said Bradford Jones, who chairs the Fredericksburg Regional Chamber of Commerce’s legislative affairs committee.

Jones, a partner in PBGH accounting firm’s Fredericksburg office, said he wondered how this will impact the upcoming presidential election and what steps Congress will take to possibly repeal the act.

“[Speaker of the House John] Boehner said he still intends to repeal it, and the Romney camp is against it,” he said, adding that the fate of the act probably won’t become clearer until the first quarter of 2013.

Julie Irving, who owns Clear Day Healthcare Staffing in King George County, said she was surprised by the court’s 5-to-4 decision.

She personally thinks it was good for a number of reasons, including the fact that her small company will likely be busier than ever as more people get insurance and seek health care.

The downside is that Irving will need to figure out the logistics of paying health insurance for those among the 100 temporary health care providers on her staff who qualify for it beginning in 2014.

“The American Staffing Association is fighting this because we’re unique employers with a high turnover,” Irving said. “Someone could work for a week and then not work again for six months.”

She said that what may happen is that temp agencies will  be required to provide insurance only for those who work an average of 30 hours a week for a month. Some agencies may decide that it’s less expensive to pay the penalty than to provide insurance.

“We’ve got a year and a half before we have to worry about it,” Irving said.

Joe Wilson, who owns  PermaTreat Pest and Termite Control  and represents small business on the governor’s Virginia Health Reform Initiative, said that the federal government needs to do something about health care, but is concerned about what the ruling could mean for the future.

“The government already tells us what kind of light bulbs to buy, the kind of toilets to put in our bathrooms and the kind of gasoline to put in our cars—ethanol. Now they’re telling us we have to buy health insurance. What’s next? Where does it end?”

Wilson said the ruling won’t have an impact on his business, but noted that it  means Virginia will need to go ahead with plans to create health care exchanges. The act calls for these state-based, competitive marketplaces for private health insurance to be in place by 2014. They will provide Americans and small businesses with “one-stop shopping” for affordable coverage.

Currently, nearly 1.1 million Virginia residents are uninsured, or about 14 percent, according to the federal government’s Center for Consumer Information & Insurance Oversight.

Wilson said he wonders what would happen if a

state decided not to expand Medicaid coverage to anyone who meets specific poverty guidelines since the Supreme Court also ruled that the federal government cannot take away Medicaid funds from states that decline to expand coverage.

Virginia now provides Medicaid funding only for some segments of the population  that meet poverty guidelines. The federal government picks up about half the tab.

“If a state opted out, where do the folks go?” Wilson said. “I guess the answer would be the free clinics and the emergency room or they go without, which probably happens more than we realize.”

People who work for the state of Virginia already receive some  benefits under the act that aren’t required to be in place yet, said Sabrina Johnson, associate vice president and director of human resources at the University of Mary Washington.

Full-time employees are not denied coverage for pre-existing conditions, their health insurance kicks in the first day of the month after they’re hired instead of after a long waiting period, and  there is no maximum lifetime benefit. Instead, the state’s insurance plan refreshes every year.

“We think it’s important that health care be available to everyone,” Johnson said. “I think that we’re moving in the right direction.”

Cathy Jett:  540/374-5407

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