 “Between 1999 and 2007, the percentage of people under age 65 years with private insurance declined, while enrollment in public coverage programs expanded.” – Health, United States, 2009
For 33 years, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) has compiled a report that provides the U.S. government with an annual snapshot of the overall health of our nation. Published in February 2010, Health, United States, 2009 was released by the Secretary of the Department of Health and Human Services to the president and congress.
The report maintains that health insurance coverage is an important determinant of access to health care. For example, between 1984 and 1994, private coverage reflected a decline among people under 65 years of age, while Medicaid enrollment and the percentage of those with no health insurance increased.
“After rising to 73% in 1999, the percentage with private health insurance declined, reaching 67% in 2007. This decrease has been offset by an increase in Medicaid or the Children’s Health Insurance Program (CHIP), resulting in little change in the percentage of persons under 65 years of age who were uninsured.”
Since 1990, personal health care expenditures paid by Medicaid have increased an average of 9% per year; Medicare 8% per year; private health insurance 7% per year; and out-of-pocket payments 4% per year.
The report also states that “Between 1990 and 2007, total personal health expenditures tripled, increasing from $600 billion to $1.9 trillion. In 2007, slightly over one-half of personal health care expenditures were paid by private sources, including private health insurance, out-of-pocket payments by consumers, and philanthropy or other privately provided care. Public sources paid the remaining $850 billion, with the bulk being paid by the Medicare and Medicaid programs.”
Patient Protection and Affordable Care Act
On March 23, 2010, President Barack Obama signed comprehensive health reform legislation, known as the Patient Protection and Affordable Care Act. For the past year, despite the nation’s economic woes, health care reform has been front and center, dominating the public discourse and political chatter from Washington, D.C. It would have proven virtually impossible for any concerned citizen not to have seen daily coverage of the debate on all the national TV news networks or to not have shared a conversation with family, friends, neighbors, or co-workers during the yearlong debate over our nation’s health care crisis.
Although the issues surrounding the debate are complex and solutions difficult to discern, the fact is that the current American health care system is fundamentally unsustainable. Pro or con–– whether you favor or oppose the recently approved health care reform plan–– many of us would agree that health care reform is urgently needed, and it is clear that this legislation will incrementally transform our health care system.
Critics have been vocal in expressing disappointment that potential cost-reducing proposals, such as legal tort reform, which would shrink malpractice exposure for health services providers or increased competition among health insurance plans across state boundaries that would result in competitive pricing for services–– are not contained in the legislation.
Transforming the Health Care System
In Pennsylvania, according to the U.S. Department of Health and Human Services, as many as 1.3 million residents who do not currently have health insurance and 683,000 who have non-group insurance could get affordable coverage through the newly established state Health Insurance Exchange. In addition, up to 2.2 million senior citizens would receive free preventative services, and a significant number of seniors will see reductions in the costs of prescription drugs under the Medicare Part D program.
Scott Harrington, a professor of Health Care Management and Insurance and Risk Management at the University of Pennsylvania, in an article titled, The Health Insurance Reform Debate, published in November 2009, concluded the following: “The broad reforms… will transform US health insurance. Significant expansion in health insurance coverage would be achieved through an individual mandate and by expanded eligibility for Medicare, by substantial explicit and implicit premium subsidies, and by a federal government prescription of individual and small group health insurance benefits, coverage, underwriting, and rating. These changes would improve access to and affordability of health insurance and health care for millions of residents, with significant costs to taxpayers and other insurance buyers, and uncertain long-run effects on the supply of medical care.”
Many believe that the Obama plan as signed into law, though transformational, is merely the beginning of the nation’s reform of health care delivery and the methods for paying for those services.
Anthony Matrisciano, speaking on behalf of Blue Cross of Northeastern Pennsylvania, told IndependentNEPA magazine that Blue Cross NEPA “is uncertain as to how the legislation will affect premiums and the delivery of services.” He expressed his belief that “the government will have to set up the necessary infrastructure to administer the new regulations and that Blue Cross is awaiting further instructions and directions from the government in reconciling the newly approved regulations with already existing Pennsylvania regulations.” Matrisciano also said that Blue Cross favored the House version that required a stronger individual mandate, with stiffer penalties for failure to obtain health insurance, explaining that the stronger mandate would have spread costs over a more diverse demographic grouping that would have included younger and healthier individuals.
There remains a debate between health care professionals as to the costs of the new reform plan. Although significant savings are expected after 10 years, the consensus is that the program will cost about $500 billion in the short term, through a tax on the robust “Cadillac Plans” and an increase in the Medicare payroll tax.
Critics are also concerned that the reforms, when implemented with mandated benefit packages, will likely result in an increase in the utilization of health services and will drive up costs even further. When benefits are mandated, individuals tend to be less concerned about costs paid by insurance plans to providers. Constraints from available doctors and hospitals in treating the newly covered and formerly uninsured will mean that supply and demand will not equal out, resulting in higher fees.
Key Reform Provisions
Clearly, there are many questions concerning changes in the new reform law that cannot be answered immediately and that may, in fact, take a decade or more to understand and interpret. A report published by the Kaiser Family Foundation outlined many of the key points of the new health care reform regulations, which have been designed to be staged-in over a several-year period.
Provisions to be implemented within the first year:
• Allow adult children to remain on parent’s insurance up to the age of 26
• Prohibit exclusions for children with pre-existing conditions
• Prohibit rescinding of policies, except in cases of fraud
• Require health plans to justify increases in premiums
Provisions to be implemented by 2014:
• Require U.S. citizens and legal residents to have qualifying health care coverage or pay a penalty
• Prohibit insurers from refusing to sell or renew policies based on health status
• Create state-based insurance exchanges for individuals and small businesses
• Prohibit health plans from imposing annual limits on coverage
Provisions Still to be Regulated at State Level:
Many states across the nation are already facing a budget crisis for the next fiscal year. Expanding state-funded Medicaid programs for low-income residents will add billions of dollars to an already strained state budget. Beyond the cost of paying for the new reforms, there are more fundamental democratic principles that have entered the discussion. Many Americans view the federal health mandates similarly to the recent Wall Street and auto industry bailouts as an extension of government intervention into their daily lives. The federal mandates have triggered a multi-state appeal to the U.S. Supreme Court, challenging the constitutionality of the new law. In fact, Pennsylvania’s Attorney General and Republican Gubernatorial Candidate Tom Corbett is among those challenging the law.
State Representative Matt Baker (R -168th), of Tioga County, who serves as the minority chairman of the House Health and Human Services Committee, spoke with IndependentNEPA.
“Anytime you make health care more expansive at the taxpayer’s expense, you make it more expensive, subject to further control of government, thereby eroding individual freedom, liberties, and choices that have made our nation great,” he said, opposing the reforms. Baker expressed concern that the anticipated expansion of the welfare Medicaid population in Pennsylvania and significant cuts of $500 billion in Medicare benefits to senior citizens does nothing to control costs, and that “ObamaCare gives more control to the massive federal government–– with more rules, regulations, and paperwork–– and enhances a culture of dependency and entitlement that is financially unsustainable.”
In an exclusive interview with IndependentNEPA, State Representative Eddie Day Pashinski (D-121st) discussed his significant concern over the sustainability of the current health care system. Although agreeing, in part, with Baker, Pashinski sees the debate in far different terms.
Pashinski has long been an advocate for health care reform and believes, “There are compelling arguments on both sides of the debate, which forces a need for further investigation.” Prior to being elected to his current seat in the General Assembly, Pashinski served as a union representative for the Greater Nanticoke Area School District’s Education Association. It was in the trenches of labor/management negotiations with the school district where he witnessed the failures of health care policy, noting that the system was not sustainable.
Pashinski stressed that “Everybody has a right to a quality health care plan, a ‘Chevy Plan.’” In an effort to identify solutions to the health care system crises, he spearheaded the formation of the Northeast Pennsylvania Health Care Reform Task Force, self-described as “a volunteer group of knowledgeable, active professionals who have come together to share their expertise, ideas, and concerns relative to our present health care crisis.”
In a report forwarded to President Obama, Vice-President Joseph Biden, and U.S. Health and Human Services Secretary Kathleen Sebelius, recommendations were made to address issues with key segments of the health market, including the health care delivery system (hospitals, clinics, doctors, etc.), insurance and pharmaceutical industries, and medical equipment manufacturers and suppliers. One of its many recommendations was the formation of a regulatory agency, much like the Public Utility Commission (PUC), to oversee and manage the health system.
Pashinski likened the health care crisis to a boat that has sprung a leak. Bailing water out of a sinking boat, in desperation, without plugging the holes, will not save the boat or its occupants. Accordingly, if we don’t lower premiums and cut the costs of health care delivery, we cannot solve the crisis. Providers and insurers cannot continue to make the profits they currently enjoy; and, duplication, inefficiency, and waste must be removed from the system. Pashinski concluded that when it comes to health care, “everybody pays for it one way or another… Nobody receives health care for free.” |
