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Guam - Full implantation of  President Obama's Affordable Health Care Act could cost GovGuam as much as $70 million additional dollars a year.

That was one of the sobering highlights of  Tuesday night's forum called by Health Committee Chair Senator Dennis Rodriguez over the impact of the U.S. Supreme Court's ruling upholding ObamaCare and its impact on Guam.

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The hearing was the first of a number which have already been planned to sort through which provisions of the Health Care Act apply to Guam and how much it will cost us.

NetCare Administrator Jerry Crisostimo pointed out that there are 92 provisions in the Act and 59 have already been adopted by island insurers since September of 2010 when the Act first began to take effect.

However, there is uncertainty over whether the entire Act applies to Guam. In particular,  the individual mandate, which requires everyone to get health insurance or pay a penalty.

That is the key question.

Prior to the Supreme Court's ruling it was thought that the mandate did not apply to the Territories. But now that the Supreme Court has ruled that the mandate is a tax, it may apply.

Since Guam mirrors the U.S. tax code, it would seem that the mandate should apply here now. Yet, if it does apply, it could cost GovGuam up to $70-million dollars annually.  That is because many island residents won't be able to afford a health insurance plan, even under the "Health Exchange" option available under the Act. As a result, many more island resident could be pushed into Medicaid coverage, requiring matching funds from GovGuam which the government does not have.

On the other hand, the individual mandate may not apply to Guam,  the Obama Administration disputes the Supreme Court's characterization of the mandate as a tax, calling it a penalty.

If the U.S. Department of Health and Human Services rules that it is a penalty, and not a tax, the mandate may not apply here, and GovGuam would not be on the hook for an additional $70-million.

But island health insurers are united, the mandate requiring everyone to get coverage must apply,  or their business is at risk. They need the additional enrollees required under the individual mandate to remain profitable and pay for all the other provisions in the Affordable Health Care Act.

But neither GovGuam, or the Federal Government have sorted out all the answers, yet.

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