CULLMAN — With the nation locked into a contentious presidential election year, the Supreme Court’s upholding of the Affordable Care Act is evoking a deafening chorus of opinions from Americans of all walks of life.

Alabama lawmakers, heavily dominated by the Republican Party, are decrying the Supreme Court decision as an overstep of judicial powers and a green light for the largest tax increase in American history.

Many elected officials across the state are reeling from the high court’s decisions because of worries over the impact President Obama’s initiative will have on Medicaid, which already consumes the bulk of the General Fund. Those leaders are also worried that small businesses will be harmed by the insurance requirement and may back away from expanding and hiring new employees.

One figure who is key in the state’s eventual approach to the health care law is Dr. Don Williamson, the state’s public health officer and Gov. Robert Bentley’s choice to chair the Medicaid Transition task force. While he is well aware of the political struggle afoot over the plan, his focus rests on the financial reality of what the Supreme Court has upheld.

“No one fully understands everything in the ruling. We have 193 pages to look through and carefully consider,” Williamson said Thursday in an interview with The Times.

“The good thing is there is time to do this right,” he said. “It affects the entire health care system, and of course the General Fund is already in a crisis. My role is to pull together the very best numbers I can for the governor. Ultimately, the decision on where to go from that point will be made politically.”

Sen. Paul Bussman, R-Cullman, was traveling to Montgomery for a meeting with fellow Republicans when he stopped to talk by phone to The Times about the court’s ruling.

“It’s the biggest fraud ever pulled on the American people. The problem we have now is the state of Alabama will not be able to survive the Obamacare mandate. That’s unacceptable. I will do everything I can to limit the scope of Obamacare in Alabama,” Bussman said.

The senator said adding more financial burden on the General Fund would leave the prison system, the judicial system and other services tied to the budget broken.

Bussman said he hopes voters will defeat President Obama in his reelection bid and pressure Congress to strike down the health care plan.

“We already have an issue in Alabama with a shortage of physicians. This will overrun those that we have,” Bussman said. “I personally hope this becomes like a Pearl Harbor and the American people say they’ve had enough. The only way to repeal this is to get (President Obama) out of office.”

Williamson agreed that Alabama has a shortage of physicians, which raises another issue he will consider in making recommendations to the governor.

With an estimated 900,000 Alabamians receiving Medicaid, moving forward with the president’s plan through Medicaid would add an estimated 400,000 people to the program.

“I’m not going to say what cost this would be specifically, because that’s just too difficult to say at this time. We do know it would be in the tens of millions for the state,” Williamson said.

In an effort to clarify the expense to the state, Williamson noted that the cost to the state for the first three years under the health plan would strictly come from an administrative position. Enrolling the newcomers to Medicaid, beginning in 2014, and maintaining their status would be a permanent cost. The federal government would  pay 100 percent of the actual health care costs.

Nonetheless, the state would be required to begin paying 10  percent of the health care costs in 2017, in addition to the continued administrative burden.

He also said a determination will be made if the federal plan offers any type of subsidies for health costs to individuals. Many questions remain and will take time to answer.

“As a physician your thought is to provide the very best care with what you have available,” Williamson said. “In a perfect world you would never make any sacrifices. What you’re trying to do is maximize what you can do for the greatest number of people.”

Williamson said the General Fund has reached the breaking point and cannot take on additional burdens. And while he is concerned about the shortage of physicians across Alabama, he said addressing the federal health care plan should be done through existing resources.

“Generally, that is my thought. I have given some thought about the role public health departments could play in this, but building on the existing community of doctors we have may be the best route,” he said.

Rep. Jeremy Oden, R-Vinemont, said the state did gain protection from federal government penalties if it chooses not to push enormous increases through Medicaid. But his greatest concern at this time is for small businesses.

“It’s an overreaching of power by the federal government. What I’m doing is writing letters to fellow legislators and our representatives and senators in Congress. We need to encourage a repeal and look at something different,” Oden said. “Telling the owner of a small business that you must provide insurance will force some out of business and cause others to hold up on hiring and investing. That’s not where we want to go.”

Oden said the fact that the state will not be forced to redefine the poverty line and pump up Medicaid is one part of the ruling he finds favorable. Otherwise the state would be funding Medicaid at nearly $1billion annually, leaving little room to keep the prisons and other services operating.

“This will be the largest tax increase in history. If an employer or individual declines coverage, they could be penalized. I think that’s an overstep of power. One of my main concerns at this time is for the business community and the impact that could have on our economy. I know there is still a lot to understand about the ruling and we will continue to study and see what everything means,” Oden said.

THE LOCAL EFFECT

Check back at cullmantimes.com for stories on how the health care law will effect local medical providers, businesses and patients.

* David Palmer may be contacted at 256-734-2131, ext. 213, or dpalmer@cullmantimes.com.