This opinion piece also appears in the June 28 edition of The Plain Dealer.

Every day, we at MetroHealth see firsthand the challenges that people without insurance have in maintaining their health. All too often, the lack of regular doctor visits and medications result in illness or life-threatening complications which might have been avoided with primary care coverage.

The Supreme Court’s decision to uphold the Affordable Care Act will help us to address those health challenges and advance our mission of providing care for all, regardless of their ability to pay.

We have seen an ongoing and steady increase in the number of healthcare visits that we provide for uninsured patients. Since 2008, these visits have increased by nearly 50 percent and we are on pace for 243,000 visits this year, a 7 percent increase from 2011.

Expansion of Medicaid under the Affordable Care Act won’t happen until 2014. But we aren’t waiting until then to get more help for the estimated 157,000 Cuyahoga County adults who don’t have health insurance.

MetroHealth is working with the State of Ohio to obtain approval for a Medicaid waiver. The waiver would provide health coverage for about 20,000 of those uninsured adults ages 19 to 64 who are at or below 133 percent of the federal poverty level, meaning their annual income is no more than $14,856.

The program is being designed to include general medical care as well as prescription, behavioral health and dental coverage. If approved, this will probably be the single greatest expansion of health care for Cuyahoga County’s uninsured.

The waiver program will continue our emphasis on primary care. More than two years ago, MetroHealth created Partners in Care to provide a medical home for the uninsured. The goal is to get the uninsured the primary care they need to control chronic issues such as diabetes and heart disease. We want to keep these patients out of emergency rooms, where care is both costly and stressful.

The program has been extremely successful, with more than 17,000 MetroHealth patients signed up for Partners in Care and a measurable decline in emergency room visits by this patient population.

The Medicaid waiver will expand this effort and help prepare the safety net system and uninsured individuals for Affordable Care Act provisions which go into effect in 2014. We hope the federal government will move to approve this waiver quickly now that the Supreme Court has upheld the Medicaid portion of the law.

Reform will mean little if there are not enough physicians ready to deliver primary care to Cuyahoga County residents. To address that, MetroHealth is using a nearly $3 million grant to train more students, residents and fellows to become primary care providers in Cuyahoga County.

With all of these initiatives, MetroHealth is ahead of the curve in planning for and implementing health care reform.