Want to know what's happening next in healthcare?

MedCityNews is the leading online news source for the business of innovation in healthcare.


“MedCity news is a peerless national resource for those of us who really want to stay on top the very latest news in healthcare from incumbents to startups. ”

Elliot Menschik, DreamIt Ventures partner; Venturef0rth founder; Penn professor


Sign up for our daily newsletter


The Affordable Care Act explained, without politics

October 9, 2013 1:40 pm by | 2 Comments

online health insurance exchanges

Sheldon Weisgrau, director of the Health Reform Research Project, said during the second of three local presentations about the Affordable Care Act on Tuesday that there was no way he could explain the law in an hour, but he hoped to provide a broad overview of it free from politics.

"Most people have gotten their information about this law filtered through the political process over the last three years, and as a result, I think the vast majority of people don't know much about the law, and much of what they do know is misinformation and politics," he said.

The Health Reform Research Project, based in Topeka, is a Kansas Health Foundation-funded initiative to provide education and technical assistance to consumers and other stakeholders in the implementation of health reform and the Affordable Care Act in Kansas.

The Garden City Area Chamber of Commerce and a variety of other community, educational and governmental organizations sponsored Weisgrau's presentations, which were designed to be a non-political explanation of the Affordable Care Act. He gave three presentations on Tuesday: at 7:30 a.m. in the Pauline Joyce Fine Arts Auditorium at GCCC; 1:30 p.m. in the city commission room of the City Administrative Center; and 7 p.m. back at the Pauline Joyce Auditorium.

Advertisement

Weisgrau said he would not argue politics with anyone, and whether people like the law or not, it is the law of the land and will be implemented, so people need to understand its impact.

The law intended to address a series of problems in the health care system, including access, quality of care and cost.

"If you remember nothing else, remember this: We do not have the best health care system in the world," he said. "Our health care system is riddled with problems from top to bottom, and this law hopes to address at least some of those."

Weisgrau said there are 48 million uninsured in the U.S, including 360,000 uninsured in Kansas. Finney County has one of the highest rates of uninsured in the state at 22 percent.

Quality of care largely depends on where people live, their socio-economic status and race. Weisgrau said it's estimated that 100,000 people die each year in the hospital, not from what they originally went there for but due to things like infections after being treated.

Yet under the current system, providers are not rewarded for quality, he said. They get paid the same whether they did a good job or a bad one.

And health care costs the past 30 years have gone up two to four times faster than wages or the rate of inflation.

All of those factors led Congress to pass the law to address problems in the health care system.

The law is big at 906 pages, Weisgrau said, because it covers every aspect of the health care system.

"It drives me crazy when I hear somebody say all these pages and nothing about the cost of care. Anybody who says that I know, they either haven't read it or they're making things up, because 200 of 900 pages deal with the cost of care," he said.

Weisgrau said some politicians claim the law came out of nowhere and was jammed down the public's throat, but in reality, health care reform has been talked about for 100 years, going all the way back to Teddy Roosevelt's 1912 presidential campaign platform.

"We've been talking about this for a long, long time, and the problems we've been trying to solve have been building for a long, long time," he said.

The law's goals are to make health insurance coverage more available and affordable for legal residents, and to reform delivery of health care to improve quality and cost effectiveness, he said. Undocumented immigrants are not covered.

"I've been working in health care for 30 years. That's a long time. I've never seen us as angry at each other as we are about this law," he said. "I've had people scream in my face about this. Call me a liar, call me a communist. Just for talking about it, which is interesting because this law is not changing a whole lot of anything."

The ACA builds on the existing system of coverage, Weisgrau said. Most people pay for health care with private insurance, and some pay for health care with public insurance like Medicare or Medicaid, and neither of those methods are changing.

The law does not create "government-controlled" or "socialized" health care.

"All the rhetoric about a government controlled system is just that -- political rhetoric. The government has no more control over health care than it does now," he said.

There are no death panels, he said, adding that it does not eliminate or change Medicare.

"Medicare beneficiaries are the age group most terrified of this law," he said. "They are the age group least affected by this law, and the changes to Medicare are largely beneficial."

Weisgrau said when fully implemented in three to five years, the law will extend health insurance coverage to 25 to 30 million uninsured. He said the three main things the law does are:

-- It prohibits insurers from denying coverage to those with pre-existing conditions or from charging them more.

-- It mandates that most people maintain insurance coverage.

-- It provides tax credits to help individuals and small businesses purchase insurance.

The reason for the mandate for everyone to have insurance is to keep healthy people in the coverage pool, Weisgrau said. He said if healthy people dropped coverage, it would cause premiums to go up and lead to more healthy people dropping coverage, something called the "death spiral" in the insurance industry.

"If you like the idea that anybody can buy a policy with pre-existing conditions, then you have to have some way to make sure all the healthy people are in the system. Otherwise, it doesn't work," he said. "The reason for the mandate is to protect the financial viability of private insurance companies."

Tax credits are available to help those with low incomes between 100 percent and 400 percent of the federal poverty level pay premiums through the insurance marketplace.

However, people below poverty level are being left out. Weisgrau said the law originally included those individuals in expansions of the state Medicaid programs. But the Supreme Court, while upholding other parts of the law, changed the requirement for states to expand Medicare, making it optional. Some states, like Kansas, have chosen not to expand the program, which will leave 130,000 Kansans living below the poverty level without coverage.

Kansas, like 30 other states, also declined to set up an insurance marketplace where individuals without insurance could find insurance companies to sell them insurance. In those states, the federal government will step in to create and run the exchanges.

Weisgrau said the vast majority of people won't be affected by the marketplace. It does not affect people on Medicare, Medicaid or who get insurance through a large employer, but it could affect small employers if the employer chooses to shop for insurance in the marketplace. However, he said, there's no requirement that they do so.

"It's designed for people who are uninsured, and for people who do not get it through their jobs," he said.

The law takes effect Jan. 1. Open enrollment through the exchanges began Oct. 1 and will continue through March 31.

Regarding employers, Weisgrau said businesses with fewer than 50 employees have no obligations under the law. Businesses with 50 or more employees must provide insurance or pay fines, but that part of the law has been delayed for a year.

"The vast majority of employers with more than 50 employees already provide insurance. It does not affect a lot, but it certainly affects some," he said.

There are penalties for not providing insurance. If an employee finds insurance through the marketplace, the employer could pay a $2,000 fine for every employee above the first 30 employees, he said.

The law also penalizes employers who provide insurance not considered affordable or that doesn't meet certain value requirements. In those cases, Weisgrau said, an employer could be fined $3,000 for every employee that receives a tax credit through the marketplace.

There are no penalties for employers with fewer than 50 employees, though tax credits may be available to employers who do provide insurance, Weisgrau said.

In response to a question about how the credits and the law will be paid for, Weisgrau said they include both taxes and a reduction of subsidies the government pays to private Medicare clients.

High-income Medicare beneficiaries -- $85,000 for individuals or $170,000 as a couple -- will pay higher Medicare premiums for prescription drugs; certain higher value insurance policies will be taxed 1 to 2 percent; and a 2.4 percent tax is put on medical devices.

Consumer assistance is available through a toll-free hotline, (800) 318-2596, and online at www.healthcare.gov and the Kansas Insurance Department website, www.insureKS.org.

Due to the technical glitches at the federal site, welldocumented in the media, Weisgrau urged people to go to the state website for the next few weeks.

"It's not working real well because there's been five times what was expected," Weisgrau said of the federal website's glitches.

Weisgrau has 30 years of experience in health policy and has worked in the public, private and nonprofit sectors to ensure the delivery of healthcare services in rural and underserved communities and to enhance the knowledge and engagement of healthcare consumers, providers and policymakers.

He earned his undergraduate degree from Cornell University and a master's degree in health policy and management from Johns Hopkins University School of Public Health. ___

Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
2 comments
William Waters
William Waters

Why don't the republicans come up with ideas to help improve the ACA instead of trying to tear down or repeal the ACA? They are so partisan they don't care if 30-40 million people remain uninsured. Something has to change in our health care system, It's not right for everyone who pays for their own health insurance and have to pay higher costs to help pay the ones who don't have insurance. People don't understand that only about 10% of the population will be affected by the ACA. What is so bad about insurance companies not being able to deny you insurance because of pre-existing conditions or a child staying on a parents insurance plan until the age of 26. If people will give the ACA a chance, in the near future it will turn out to be a really good thing for our country.

deeman
deeman

This is more PROPAGANDA, folks. No mention that the ACA was passed without bipartisan support. No mention that the Repubs had ideas for health care that weren't included in the law. No mention that insurers can drop you for poor payment history or credit score. No mention that some policies are going to double, triple, quadruple because of mandatory changes to the coverage. No mention that if the ill have the same rates as the healthy that that rewards poor behavior. No mention that companies will now find it palatable to drop family coverage in favor of the exchange to lessen costs. Etc, etc, etc. 


If you read the article, you'd think the Affordable Care Act was a poorly misunderstood law that was really the next best thing to sliced bread. Maybe the author is the one that misunderstands, but I'm thinking that he got it wrong on the merits of the law. To paraphrase Pelosi, we won't know how bad, unfair, antiAmerican, bloated and illogical it is until we've used it awhile.

Hear the latest news first

Get our daily newsletter or follow us.

Advertisement