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Forum: Obamacare will help US if improved, not abandoned

Forum: Obamacare will help US if improved, not abandoned

Forum: Obamacare will help US if improved, not abandoned

Bulloch County Democratic Party Chair...


"Don't throw the baby out with the bathwater" was the crux of Paul Ferguson's remarks about the Affordable Care Act at Saturday's forum on the health-reform law, also known as "Obamacare."

Ferguson, the director of Georgia Southern University Student Health Services, chaired a group that researched the law in putting together a health insurance exchange for all 32 schools in the University System of Georgia. He was one of two main speakers at the forum, hosted by the Democratic Party of Bulloch County at the Honey Bowen building.

Jill Lockwood, a tax attorney and GSU accounting professor, spoke briefly about the law's tax implications.
Georgia is one of 27 states that have refused to set up state health insurance exchanges for the public, according to the Kaiser Family Foundation, a nonpartisan think tank that focuses on health policy analysis. Because of that, residents who need health coverage through an exchange must sign up through the federal exchange by phone, by mail or at the website www.healthcare.gov. The exchanges were launched Oct. 1, but the federal site has failed to operate properly, as have some state exchanges.

Acknowledging this, Ferguson said that the law nevertheless brings needed changes to America's health-care system.

"We're hearing a lot of folks saying now that because the online program is essentially not working very well, we should go back to the way it was because it was a wonderful system, and if it was such a wonderful system, we wouldn't have to do what we're doing in terms of health care reform," he said.

The United States has "one of the best, and most costly, health-care delivery systems in the world, while at the same time of the world's worst systems of health care access," Ferguson said.

Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest rates of infant mortality, heart disease and lung disease and sexually transmitted diseases, among other factors.

"Yes, we have a wonderful system," Ferguson said. "The problem is the access to that system and where the resources are placed in the system. I believe the Affordable Care Act does attempt to address some of those issues. Does it do it perfectly? Lord knows, it does not."

But Ferguson listed ways in which he sees the law already making a positive difference.

Previously, insurance companies spent as much as 40 cents of every dollar in premiums on overhead, marketing and executive's salaries. The law requires them to spend at least 80 percent of premiums on health care or improvements to care.

It is now illegal for insurance companies to deny coverage to children because of pre-existing conditions such as diabetes and asthma. This protection is scheduled to be extended to adults in 2014, but many insurers have already voluntarily complied. It is now illegal for insurance companies to put a lifetime cap on how much they will pay, or to use a paperwork mistake as a pretext for not paying when someone is sick.

Young people through age 25 can now remain under their parents' plans - instead of facing a cutoff at 18. Insurers are now required to cover the full costs of many preventive health services, such as screenings and vaccinations. With his role at the university and 35 years as a health-care professional, Ferguson especially likes these provisions.

"Providing primary care and preventive care — including, for example, flu vaccine — makes an awful lot of sense ... from both a health standpoint and a financial standpoint," he said. "The cost of providing that flu vaccine is much, much less than the outcome of having full-blown flu."

He provided lists of pros and cons, and fiction vs. fact, of the Affordable Care Act. Here are examples.

Pros and Cons

Pro: An estimated 32 million previously uninsured Americans are supposed to have coverage or be able to get it as of January 2014, including young adults ages 19 through 25 previously dropped from parents' plans, patients with pre-existing conditions and people who couldn't afford coverage.

Con: Americans who don't pay for insurance and don't qualify for Medicaid or an exemption will be assessed a tax of $95 (or 1 percent of income, whichever is higher) for 2014, rising to $325 (or 2 percent of income) in 2015 and $695 (or 2.5 percent) after that. Meanwhile, employers who offer no health insurance and have more than 50 employees will face substantial penalties ($750 per full-time employee) if even one of their employees signs up for coverage through an exchange.

Pro: Health-care costs should be reduced over time, according to Congressional Budget Office projections. This will largely be due to prevention and people getting treatment sooner, and it will take time, Ferguson emphasized.

Con: The law is projected to lead to a shortage of health-care professionals.

Pro: Medicaid will be extended to people earning up to 133 percent of the federal poverty level, currently $15,281 for an individual or $31,321 for a family of four. Small businesses will be able to get subsidies if they purchase insurance through an exchange.

Con: The law has no provisions to control the increased cost of medical malpractice insurance resulting from frivolous claims.

Fiction vs. Fact

Fiction: If you don't buy health insurance, you will go to jail.

Fact: Taxpayers who fail to purchase required insurance will receive a notice from the Internal Revenue Service about the penalty they owe. But individuals who fail to pay the penalty are not subject to criminal prosecution or liens, Ferguson said.

Fiction: All individuals with an existing health insurance plan will be allowed to keep that plan.

Fact: Individuals whose existing health insurance plan does not meet the health-care law's minimum essential coverage guidelines (covering at least 60 percent of cost of mandated benefits) were being required to enroll in a plan that meets those requirements.

President Barack Obama recently acknowledged that his earlier promises about everyone keeping their coverage were inaccurate. Last week, he announced a rule change intended to allow people to keep policies that do not meet the minimum requirements, but the effects are being debated.

That situation, and continuing difficulties with the federal website, should not prompt Americans to scrap the ACA entirely, Ferguson said. Citizens and politicians, he asserted, need work together to fix and improve it.

"I believe that the old saying, ‘Don't throw the baby out with the bathwater,' applies with regard to the implementation of the Affordable Care Act," he said. "It's a law. It's been upheld by the Supreme Court. What I would prefer is that we try to keep the pros, and in a reasonable, rational, collaborative way, address the cons for the benefit of everyone."

 

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