Whether they’re for the historic health-reform bill or against it, local health-care and business leaders agree big changes likely are coming as a result.
Some portions of the legislation could go into effect in as soon as three months, while others will take until 2019 to be fully implemented.
While many of the details still are unclear, area industry leaders shared these thoughts Monday about what they think the effort to extend health care to tens of millions of uninsured Americans will mean for consumers and businesses in the region.
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• Ed Byers, spokesman, Medical Mutual of Ohio
Medical Mutual of Ohio, one of the state’s largest health insurance companies, still is evaluating what the reform bill will mean for its 1.6 million enrollees.
”Until we understand the details of the rules brought about by the proposed law, it’s very difficult to predict how they will be implemented or their impact,” Byers said. ”It’s going to take time and effort to understand the implications.”
• Bill Considine, president and chief executive, Akron Children’s Hospital
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Akron Children’s frequently sees families who can’t get coverage for a child with a pre-existing condition, Considine said.
The hospital also treats patients who surpass their lifetime insurance maximum because of conditions such as cystic fibrosis, sickle cell disease, blood disorders, congenital heart defects and other serious problems, he said.
The health-reform measure passed addresses both those issues.
”There are more people now that will have access to insurance, and there’s also going to be more of a focus on prevention,” Considine said. ”That’s a plus from our perspective.”
However, Considine said, he’s disappointed the bill doesn’t address Medicaid funding for pediatric specialists and hospitals, which typically get paid less through Medicaid than adult hospitals get from the Medicare program that covers Americans 65 and older.
• Dr. Richard Ellison, an Akron ophthalmologist and president-elect of the Ohio State Medical Association
Ellison said he’s concerned that while more people will get insurance coverage, ”having coverage doesn’t necessarily mean they’ll have access to care.”
Initially, he said, the measure will increase Medicaid funding for primary-care doctors, which should help provide access to health care as more people become eligible for the public insurance program.
”I have some concerns about that lasting long enough for people to maintain access,” he said.
Another aspect that will allow children nationwide to remain on their parents’ insurance until age 26 should help younger individuals who can’t afford coverage, he said.
Ohio already has a measure to allow children to stay on their parents’ plan until age 28, effective in July.
Doctors also are concerned that the bill didn’t include provisions to address tort reform, nor did it address scheduled cuts in federal payments to physicians, he said.
• Marty Hauser, president, SummaCare
SummaCare, an Akron-based health insurer that’s part of Summa Health System, is dedicated to continuing to offer Medicare managed-care plans, even though insurers are anticipating reductions in federal payments, Hauser said.
SummaCare also supports plans to forbid insurers from denying coverage because of pre-existing conditions, as long as people are required to get coverage, Hauser said.
The mandate for most individuals to have insurance coverage doesn’t go into effect for several years.
”We think it’s a good thing to do,” he said of eliminating pre-existing condition exclusions. ”The challenge is going to be how they expand the coverage or in some cases require coverage so there’s a pool of healthy people who can help offset the expenses.”
Overall, Hauser said, ”I think they’re going to accomplish that intent of getting people covered. The question that remains uncovered is how is it going to be paid for and who’s going to pay for it.”
• Dave Petno, health insurance broker from Hudson and media chair, Ohio Association of Health Underwriters
Petno said he’s convinced the new rules will drive up the cost of health insurance.
The requirement to cover pre-existing conditions ”basically means that people can have no insurance and then when they get sick, they can have access to insurance and get insurance right away with no denial,” he said.
As a result, he said, healthy people might opt to wait until they get costly illnesses to seek coverage — an action that would raise the cost of health insurance for everyone.
”The pre-existing condition exclusion is one of the few things that gave people an incentive to actually buy insurance,” Petno said.
A requirement that most individuals obtain coverage or face penalties starting in 2014 won’t help because it won’t be enforceable, he said.
”Insurance premiums are going up,” Petno predicted.
• Richard F. Rebadow Jr., executive vice president, Greater Akron Chamber
The Greater Akron Chamber has been in support of ”market-driven solutions that control growth in health-care costs,” Rebadow said.
But local business leaders — particularly small employers — have a lot of unanswered questions about how the new rules will affect them if fully implemented, Rebadow said.
”They’re not sure what that really means until the process plays out a little bit more,” he said.
It also remains unclear what will happen if most employers are required to provide coverage or pay penalties starting in 2014, as written in the bill.
”The way the bill is written, as I understand it, some companies could pay the penalty, which would be a lot less than paying for the coverage,” he said. ”Time will tell.”
• Marsha Schofield, program director, Access to Care
The Access to Care program links about 1,750 uninsured Summit County residents with volunteer doctors who agree to provide care for free.
Schofield estimates about 70,000 Summit County residents (about 13 percent) lack insurance. Many simply can’t afford it, even if it’s offered through an employer.
The subsidies and other provisions ”should reduce the number of people who are uninsured in the community and eligible for our program, which, from our standpoint, is a good thing,” she said. ”There were already many, many more people eligible for our program than we could serve.”
• John Sniezek, chief executive, Akron Community Health Resources
At Akron Community Health Resources (ACHR), almost half the patients lack health insurance. ACHR provides medical and dental care on a sliding fee scale for the uninsured.
The federal measure should help more patients get coverage, particularly those who have been denied insurance because of a pre-existing medical condition, Sniezek said.
The health reform bill also includes funding to help federally qualified health centers such as ACHR expand their services and add new locations so more people can get help, Sniezek said.
”I think what it does is it provides a firm safety net in time for the medically needy who have been reluctant to seek medical care because of lack of insurance,” he said.
• Mike Stull, regional vice president, Employers Health Coalition of Ohio
Employers Health is a national employers coalition based in North Canton that provides prescription drug group purchasing and other efforts to improve health-care cost, quality and access.
The health-reform bill ”will certainly improve access for people who don’t have insurance today,” Stull said. ”The subsidies that are part of this bill will help make insurance more affordable.”
However, he said, the provisions most likely will result in higher premiums in the short term because of provisions that eliminate annual caps and restrict deductibles.
The reform bill also will affect employers who offer retiree coverage. Changes in federal subsidies will likely result in higher costs for businesses.
”It’s just a matter of will it cost them so much that they don’t want to continue coverage,” he said.
Cheryl Powell is a health reporter for The Akron Beacon Journal, the daily newspaper in Akron and a syndication partner of MedCity News.
