A ruling, a report, a retreat and a major deal

The health care world produced several major items of interest Wednesday.

The eventful day was capped by a ruling from a federal appeals court in favor of the ‘’individual mandate’’ provision of health care reform.

The court ruling in Cincinnati followed a report earlier in the day on the impact of proposed Medicaid cuts on the U.S. and on Georgia; the Obama administration scrapping its “secret patient’’ idea; and a large health insurance company striking a deal to buy a hospital system in Pennsylvania.

The Affordable Care Act requires nearly all Americans to purchase health insurance by 2014 or face financial penalties. The mandate provision in the 2010 law has been challenged by a number of groups and individuals, as well as numerous states.

The three-judge panel of the 6th U.S. Circuit Court of Appeals, in a 64-page opinion, said, “We find that the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause.”

The opinion Wednesday was the first of three rulings on the Affordable Care Act that have been eagerly awaited from federal appeals courts around the country, and the remaining two are expected later this summer. One of those is in Atlanta, from the 11th Circuit Court of Appeals, which held a hearing in June on a challenge by 26 states, including Georgia, against the much-debated law.

Thus far, five federal district court rulings have been issued on health reform, with three saying the law is constitutional and two saying it is not. Given the conflicting findings, the issue will in all likelihood be settled eventually by the U.S. Supreme Court.

Until Wednesday, all the lower-court findings had split directly along party lines. But in Wednesday’s 2-to-1 ruling, a judge appointed by a Republican president joined one named by a Democrat to write the majority opinion.

Meanwhile, the consumer advocacy group Families USA reported on the impact of proposed spending cuts on Medicaid, the government program for the poor and disabled.The report, titled “Jobs at Risk,” said that if a 5 percent cut in Medicaid spending were to occur, as proposed by Republicans, the 50 states and the District of Columbia would lose $13.75 billion needed to support health care for Medicaid recipients.

In Georgia, a 5 percent cut in Medicaid spending in 2011 would cost the state nearly $288.7 million in federal dollars and put at risk about $670.2 million in business activity and 5,820 jobs, Families USA said. The job impact in Georgia would be 12th-highest nationally, the report said.

For subsequent 15 percent and 33 percent cuts, the impact would be much higher, Families USA said.

‘’The economic recovery in Georgia is still fragile, and cuts to the Medicaid program would set us back while also negatively impacting access to health care services for some of our state’s most vulnerable citizens,” said Cindy Zeldin, executive director of Georgians for a Healthy Future, in commenting on the economic impact report.

“Medicaid is an economic generator for Georgia, and we urge Congress to bolster rather than cut it,” she said.

Medicaid is jointly financed by the states and the federal government. It covers about 1.6 million Georgians.

Republicans have called for Medicaid to shift to a block grant, with each state getting a lump sum and more flexibility to run the program as it wishes. Georgia Gov. Nathan Deal has said he supports such an approach.

Julie Eckstein, a vice president and state policy director of the Center for Health Transformation, said an increase in jobs, ‘’especially for Medicaid enrollees,’’ is at the center of Republican ideas to reform Medicaid. That, in turn, would increase self-sufficiency and reduce dependence on government programs, she said.

“I think we would all agree that assuring services for those truly in need who cannot work is the role of our safety net,’’ Eckstein said. “New models of allocating Medicaid dollars to the states will allow them to do that and get a handle on their ever-growing budgeting woes.’’

In another development, the White House is retreating from a plan to have “mystery shoppers” pose as patients who would call doctors’ offices to see how hard it was to get appointments, the New York Times reported Wednesday.

The idea drew strong criticism from doctors and lawmakers. On Sunday night, administration officials had staunchly defended the survey as a way to measure access to primary care, and insisted that it posed no threat to privacy, the Times said.

And the Wall Street Journal reported Wednesday that Pittsburgh insurer Highmark reached a stunning deal to acquire the second-largest hospital chain in its region. The Journal called it ‘’an ambitious, controversial step that would further blur the lines between those who pay for medical care and those who provide it.’’

Nonprofit Highmark would pump as much as $475 million into the five-hospital West Penn Allegheny Health System, which has been losing money for five years.

Highmark said the deal would help the organization move away from payment systems that reward medical providers based on the number of services they deliver, rather than on the quality and efficiency of the care, the Journal reported.

It’s another sign of the recent scramble among medical providers and insurers who are looking hard to cut costs.