ACA: Insurance not health

Colorado Springs was originally founded, in part, as a healthy place with a healing climate. Patients suffering tuberculosis and consumption would wrap in blankets while reclining on the stone veranda of Cragmor Sanatorium (now the site of UCCS). Unfortunately, such treatment was usually limited to the upper class. Photo courtesy Pikes Peak Library Digital Collections

Colorado Springs was originally founded, in part, as a healthy place with a healing climate. Patients suffering tuberculosis and consumption would wrap in blankets while reclining on the stone veranda of Cragmor Sanatorium (now the site of UCCS). Unfortunately, such treatment was usually limited to the upper class.
Photo courtesy Pikes Peak Library Digital Collections

Athena Roe

Many Americans are in the dark when it comes to deciphering the health care legislation called the Affordable Care Act (ACA). A recent survey showed that 90 percent of physicians believe that the public has not been properly educated about how health plans will function under the ACA.

Part of the confusion is that the ACA is not about healthcare, it’s about insurance. The ACA, often referred to as “Obamacare,” comprises two separate pieces of legislation, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

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Under the ACA, there exists the controversial individual mandate provision, which requires you, your children and anyone else that you claim as a dependent on your taxes to have health insurance in 2014 or pay a penalty.

There are exceptions to the individual mandate. Examples include individuals whose household incomes fall below the minimum threshold for filing a tax return, illegal immigrants and those whose religion objects to having insurance coverage.

The ACA allows for states to offer consumers a means to purchase health insurance. In Colorado, consumers may go to Connect for Health Colorado’s website that offers insurance options and functions as a nonprofit exchange or clearinghouse.

If you have insurance through your private purchase, Medicare or Medicaid, or via employment, you do not need to pay attention to exchanges unless you lose coverage.

“Patient’s access to providers will be more limited on the exchange, as not all providers are willing to participate and willing to accept lower payments,” asserts Michele Law of Law Consulting.

Providers are also concerned that more bad debt and uncollected balances will occur with people who purchase on the exchanges. Low-income individuals will still have to pay for insurance even if the individual or family qualifies for a subsidy. There will still be premiums to pay co-pays/deductibles and co-insurance.

So, the question remains: will people in the low-income bracket be able to afford insurance and all the accompanying costs that go along with a policy (i.e. out-of-pocket expense with a deductible similar to a deductible one would pay on their home/renters or auto policy)? Perhaps it will be more affordable to pay the fine, stay uninsured and call it a day.

The other alternative to ACA remains the single-payer model. “Single-payer” is a term used to describe a type of financing system. Essentially, the government would operate to pay out all healthcare costs and collect fees.

Unfortunately, many Americans are adverse to government-run systems because of the attitude perpetrated by stories of socialized medicine of other countries.

But a single-payer system has the advantage of being much less expensive to run because administrative costs are reduced via standardization of medical coding and reduced bureaucracy. This is in direct contrast to the private insurance system that remains alive and well with the ACA.

Under the current system, there have been numerous reports of physicians receiving checks for as little as 43 cents from insurance companies for office visits or procedures. Imagine the administrative waste from a bureaucratic standpoint alone.

The administration and bureaucracy of healthcare in America has become the most critical booster of healthcare costs. It would logically follow, that a single-payer system would have been the least expensive choice for delivering healthcare for all Americans.

The ACA does little to reduce the tens of thousands of different healthcare organizations. It also does little to reduce the number of billing companies or HMOs in the stream of commerce.

Because of the sheer number of payers (insurance companies/plans) in the system, the administrative waste generated organizationally amounts to hundreds of billions of dollars.

Proponents of the ACA say that more individuals will have insurance and there are more preventative measures contained in health plans, but long-term, a government-run single-payer system would certainly offer a cheaper and more accessible alternative to the ACA.

Americans have the choice between hospital monopoly-type models or indigent clinics. Does this reduce the cost of health care and improve access?

Logically it seems unrealistic. The trends in healthcare legislation and model-type systems have essentially created a socioeconomic system for healthcare delivery.

Edward Dauer, a long-time healthcare law and policy professor, says the passing of the ACA was one of the most significant events since the civil rights era of the 1960s. It was a turning point in the sense that America recognizes healthcare as a legal and moral right.

“It is clear that politicians attempt to get people to think in political dialogues, to create in people’s minds an ‘ideology’ if you will, so that the ‘masses accept myth as reality,’ ” Dauer says.

Think about that for a minute. If the only message delivered is people need insurance, this creates a mindset.

Dauer said the silliness of the national dialogue is two-fold. Americans not only want more things than they are willing to pay for, but many perceive the federal government has a bottomless checking account for benefit programs.

Physicians are also concerned with healthcare reform and believe that Americans need healthcare not health insurance.

“Patients, doctors, hospitals and clinics are the pawns in an increasingly complex and unwieldy game,” said Dr. Virginia Hrywnak, primary care physician in the Boulder area. “The goals are many – best patient care, competitive costs and universal coverage. However, the real obstacles that may interfere with affordability and accessibility include insurance companies and other middlemen who stand to profit by further denigrating the basic doctor-patient relationship.”

Athena Roe is a J&P member and the founder of theharcompany.org, She holds a law degree from Denver University College of Law and has worked in the healthcare arena since 1988. This article is dedicated to Dr. Christopher N. Tulin, cardiologist, who passed away in July.

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