Guam - Government officials are trying to determine how much it's going to cost to implement the Patient Affordability Care Act, now that it has been upheld by the U.S. Supreme Court. The problem is that officials aren't sure the government will be able to afford it.

$75 million a year is precisely how much Banking and Insurance Commissioner Art Ilagan estimates it will cost the government to implement certain provisions of the Patient Affordability Care Act. "It is a tax," he told KUAM News. "As a tax, we mirror the code so it applies to Guam - that is our opinion."

Local health insurance companies had requested that Ilagan issue an opinion on whether the individual mandate applies to Guam based on the ruling from the highest court in the land. Based on Ilagan's opinion, this means that employers and individuals would be required to get health insurance beginning in 2014.

The government must also decide if it wants to participate in a health insurance exchange or opt out.

Ilagan says participating would cost the government at least $75 million. But even with a subsidy that will be divided among the insular areas, Guam would only end up with $3.75 million a year. He continued, "This is very similar to the compact impact, requiring the islands to spend what we don't have and the earned income tax credit."

"Just basing it on what it's going to cost, versus what the exchange can do for the government, what it's going to cost the government, I can't see how we're going to implement something when we don't have the funding source to make that happen."

Public Health meanwhile is looking at the impacts of the SCOTUS decision as it relates to Medicaid. The government would be required to provide a 45% match and agree to expand the Medicaid program in order to receive $268.3 million in Medicaid funding. "So now those clients who are under MIP who are single and couples can qualify for the Medicaid program as long as they meet the income and the citizenship criteria of the program," he said.

While there are pros to the Medicaid expansion, Medicaid program administrator Tess Archangel says they expect the number of clients to increase to 50,000 in just two years. "We would need workforce, we need more staff in order to implement PACA in order to meet the requirements of PACA," she explained.

Guam Community Health Centers administrator Linda Denorcey says that many people just can't be accommodated right now. "Our plan is to increase access to all these patients that are uninsured and we want to get more of the insured people to become our health center patients by 2014. We anticipate about 3,000 more new medical users. To prepare for these new users, the centers we have to increase our revenues, we have to get more funding to recruit additional doctors to provide all the types of care that we have including preventive care services," DeNorcey said.