MANKATO — While some lauded the Supreme Court’s health care law decision, it wasn’t a hit with everyone.

“My big concern is the cost it will have on the state and ultimately the county,” said Mark Piepho, a longtime Mankato Republican. “I don’t think we can afford another costly program. I’m very disappointed.”

Be that as it may, the 5-4 ruling let stand nearly all parts of a law many hope will extend health care to millions of Americans — including southern Minnesotans.

At both the Mayo Clinic in Rochester and the Mankato Clinic, officials said the ruling won’t affect changes they’ve been trying to make to cut costs and transform the system to one that focuses on people instead of procedures.

“The Mayo Clinic has sought to be the voice of the patient in this debate,” said Mayo Clinic CEO Dr. John Noseworthy. “We’ve been an active participant for years on discussions at national level.”

He said that regardless of the ruling, Mayo’s goal would have been to continue its push for what it calls “patient-centered care.”

“All of our efforts are focused on them,” Noseworthy said. “That’s a process we work on day in day out, week in week out. The decisions made today really don’t impact that.”

Dr. Julie Gerndt, Mankato Clinic’s chief medical officer, said the fact that the law has the potential to bring health care to more people is a good thing. But like Mayo, she said the Mankato Clinic already has been working on ways to rethink the way they do health care.

She cited their program to offer intensive monitoring of diabetes patient care as an example of how they’re moving toward new models of care that focus more on patients.

“We all understand we have a crisis in health care, and the escalation in costs is not sustainable,” Gerndt said. “The Mankato Clinic will continue to be innovative.”

One piece of the federal legislation that has proved popular is the provision to allow people in their lower to mid 20s to remain on their parents’ insurance plans.

Tyler Saben of Blaine, who attended Minnesota State University and has remained on his parents’ insurance while in college, said he thought that particular provision was a good one.

“I think it’s very important,” Saben said. “It takes the worry out of your mind.”

Saben said there hasn’t been much discussion among his friends about the health care bill or the Supreme Court’s decision. But when it comes to health care, he applies his own logic to it.

“My view is that it’s kind of like car insurance,” Saben said. “It’s nice to know that it’s there.”

First District Congressman Tim Walz said the ruling did nothing to change what he thinks is one of the biggest issues America faces: “My biggest concern is how do we deliver health care to the people who need it? I don’t think any of that changed one way or another.”

The Mankato Democrat said he listened to President Obama’s speech after the ruling came out and agreed with Obama’s assessment that health care reform is a journey, not a destination.

He also said he’s pretty sure he’ll be talking about this ruling for a while. Certainly until November.

“That’s my job, my responsibility, to go out and explain what’s in this law,” Walz said. “When I see people say we should have the same insurance as Congress does, I say, ‘You’re absolutely right, that’s what this bill does.’ I have refused all along to believe that this nation couldn’t find a fix for health care.”

Walz says he doesn’t see a heated debate continuing too far beyond November.

“(Opponents) are going to find the appetite of the American public to do this again is not what they think it is,” he said.

Piepho might disagree.

“It’s overreaching,” he said. “Most people would agree we need reform, but not this.”