Posted: Sep 28, 2013 4:04 PM by Dan Shadwell, KSBY News
Last week, in part one of our look at the Affordable Care Act (AKA Obamacare), we dove into the basics-what the changes will be; who's most effected; some of the options for coverage in the new plans; the deadlines for compliance; and what happens if you refuse coverage.
The online health exchange in California (coveredca.com) will go live in less than a week, but there's a pitched battle for your allegiance underway in Congress, as some members try to gut the program while others defend it.
The media is working to cover all perspectives--some clarifying, others confusing (and even obfuscating.) Some of the information you've heard on both sides is a distortion, either making the rollout seem like an imminent catastrophe or the best thing since sliced bread. Truthfully, there are some legitimate concerns and there are also some features that almost everyone agrees are big improvements over the current system (e.g. the banning of clauses that allowed insurers to refuse you coverage if you had a pre-existing condition.)
At KSBY, we're working to sift through the rhetoric and provide you with a clear, objective look at what you need to know. Before we begin part two of our report, let's recap the main points of part one: First, the major changes really only effect the 15% of Americans who don't have insurance now. In many cases, that's because they were excluded because of pre-existing conditions. Obamacare provides insurance for them.
Second, if you already have health insurance through your employer, through Medi-Cal, through Medicare, or through the Veterans Administration, you really don't need to do anything. Your coverage will likely just improve (there's a possibility your premium may be more expensive, too-but we'll get to that in a minute.)
I asked viewers on the street and on our Facebook page for their questions and concerns, then took those to some local experts. Here are the experts' responses:
Let's start with references to "death panels," an onerous idea circulated by politicians who suggested the law would spell the demise of care for the nation's elderly.
San Luis Obispo County's director of public health says that was a distortion that referred to an early aspect of the bill that would have reimbursed doctors for time spent talking to patients about the care those patients wanted in their final days. "And that was all it was," says Dr. Penny Borenstein, "...no one else making decisions, but just to encourage the average person to think about their end-of-life wishes."
Borenstein says that conversation makes good economic sense regardless of who pays for it, because up to a third of all health care dollars are spent in the last days of life. But because of the scare tactics used by some politicians before Obamacare became law, that provision didn't make it into the bill, for fear the smear campaign would kill the entire legislation.
Here's a second widely circulated rumor-that Obamacare is a government take-over.
"I actually think it's nonsense to call this a government takeover," Borenstein says. "It's very much the same health insurance system we have. Private insurers are going to pick up the slack. They're not going to be able to make quite as much profit. But they're also not going to be able to deny anyone for pre-existing health conditions."
San Luis Obispo based attorney and public health expert, Joel Diringer, says the expansion of care under the Affordable Care Act uses existing providers and doctors. He says, "no one is telling you that you have to switch doctors, particularly if you already have insurance and an established relationship with your doctor."
Rumor number three: Obamacare will alter or end Medicare. Diringer says not true. "If you have Medicare, keep it. It's yours. Nothing changes really with Medicare." He says the opposite is true-the Medicare program is expanding to pick up millions who have, until now, slipped through the cracks.
Rumor number four-the suggestion that Obamacare will kill jobs. Diringer says this question is more complicated because companies were already moving workers to part time status to save money.
"They were doing it anyway," he says. "They've been doing it for years. So, 95% of large companies already provide coverage and it's usually only for full time workers." But, he explains, companies provide that coverage because they want to retain workers who otherwise might be tempted to leave for more attractive offers-companies that did offer coverage. Diringer says that dynamic makes it difficult to assign a cause and effect correlation between job losses and employment shifts, to the Affordable Care Act.
"Yes, there's more incentive here (to move employees to less than full-time status)," Diringer says. "But frankly, for those low-income workers-and these are mostly lower income workers-they may in fact, do better on the exchange with the subsidies," he says.
Borenstein says the suggestion that the mandate for businesses to cover employees will lead to the loss of jobs, is overstated. "There's absolutely no requirement for businesses with fewer than 50 employees, to layoff workers or cut their hours," she says. "Small businesses are exempt from the employer mandate. In fact, if they choose to offer health benefits, those business owners will get big subsidies from the Federal Government."
In addition, she explains, employers of more than 50 workers won't be affected by the mandate for another year and that will provide time to workout many of the questions businesses have about implementation. "There's no mandate for them now and no reason to reduce staffing."
Finally-what about suggestions that Obamacare will increase insurance premiums?
Michael Framberger is a licensed insurance agent in San Luis Obispo with decades of experience. He gave us three examples of current rates, versus what comparable coverage will likely cost when Obamacare is fully implemented... For a 55-year-old man, the costs drop. For a 59-year-old, they increase somewhat, depending on which plans they choose, as do rates for a 32-year-old, and a 42-year-old-about 20% on average. "This will be a Godsend for people without insurance," he says. "But higher premiums will be a concern."
Diringer agrees, but says, "...keep in mind that depending on your income, you may qualify for subsidies from the federal government, which could in fact, lead to much lower premiums overall."
Coverage under the new law will also include free preventative care, low-cost co-pays, and yearly caps on your out-of-pocket deductibles and co-pays--$6400 for individuals, $12,800 for families.
Borenstein says it's important to remember that conspiracy theories about the expansion of government programs are nothing new.
"In 1965, Medicare and Medicaid came into being and there was a lot of the same talk-that this was going to be socialized medicine, that people were going to go broke, that the government was doing a big takeover and we saw that that didn't happen," she says. "Those are two of the most favored programs... particularly Medicare. Seniors can't imagine their retirement without guaranteed health insurance."
Diringer, Borenstein, and Framberger all acknowledge a real concern when it comes to the available health care network on the Central Coast.
Because we live in a relatively small community, there won't be as many insurance companies offering plans. So there will be less competition, and presumably, somewhat higher premiums. In addition, there may be fewer doctors willing to participate, as reimbursement rates to doctors may be lower than in many private plans.
"I spoke to a group of physicians here recently," Framberger says, "... and not one of them had signed up to be a provider on the plan. I think locally, we may see down in the 20-30% of doctors that are going to participate in the plan."
"If, indeed, the supply can't keep up with the demand," Borenstein says, "...then there are med schools that can enhance their census of new doctors coming out of the pipeline." Congress also may be called on to raise reimbursement rates for doctors willing to participate.
Diringer says as with any new law, this one will require refinements and fixes as the rollout begins.
But he cautions against idealizing the existing system. He says, "the next time someone says to you, ‘America has the best health care system in the world,' remind them that we spend twice as much per capita as the next closest country spends on medical care, and that's France. But when you look at health outcomes, like life span and infant mortality, we're on par with Cuba. We're not getting much for our buck."
There's a lot to review here and we've created a special section at ksby.com where you can watch our reports. Just look for the "Affordable Care Act" button in the scrolling window at the top of our home page. Let us know what you think on our Facebook page, or by firstname.lastname@example.org.
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