XYZ hosts Affordable Care Act event
Medical debt is the number one cause of bankruptcy in the United States. If you do not have health insurance, you pay top dollar for your health care. If nothing changes, Medicare will be broke by 2026.
The United States is the only developed country in the world that does not provide universal health care for its citizens. Despite spending more than any other country in the world on healthcare ($8,000 per capita) the United States ranks 31st in life expectancy.
In the face of this bleak prognosis, Dr. Lon Peterson presented a program about “The Patient Protection and Affordable Care Act” before an audience of seniors at First Lutheran Church last Wednesday afternoon. The program was one in a series of community programs developed by the Extra Years of Zest (XYZ) retiree group at the church headed up by Bev Peterson .
Dr. Peterson , a 1977 graduate of New Richmond High School, earned his undergraduate degree from St. Olaf College in 1981 and his medical degree from the University of Wisconsin Medical School in 1985. He has practiced family medicine in Hastings, Minn.,for the past 25 years and currently serves as the Medical Director of Hospitalist services at Regina Medical Center.
“One of the major social issues facing this country has been the issue of uninsured Americans and their access to medical care. The Affordable Care Act (ACA) has been the response we’ve developed and approved despite all of its political issues,” Peterson said.
“It’s the biggest social legislation we’ve had in this country since Social Security in 1965. Social Security was fraught with controversy as well and it has been revised many times. People need to understand, the ACA is a work in progress,” Peterson said.
Despite the anxiety many people are experiencing with the advent of the insurance exchanges and the mandate for individual coverage starting Jan. 1, 2014, Peterson pointed out that people are already benefiting from a number of the provisions set forth in the ACA which have been implemented. Those include insurance reform which guarantees people cannot be dropped from coverage when they become ill and the removal of lifetime maximums. The ACA also allows young adults to remain on their parents’ insurance until age 26.
The vast majority of Americans are covered by employer provided insurance plans and they will not experience significant changes due to the ACA, according to Peterson . Medicare was also left untouched by the ACA.
Peterson clarified the primary intent of the ACA was to provide access to health insurance for the uninsured.
“Speaking as a provider, we recognize that access to health care is dependent upon having health insurance. This is a positive step. Healthcare reform will be driven by the market. But access and taking care of the uninsured is really a government function,” Peterson said.
The success of the ACA depends in large part on enrolling all uninsured Americans and not just those below the poverty line. To do this, the ACA mandates that all individuals must have insurance beginning in 2014 or be subject to a financial penalty. The ACA facilitates enrollment by first expanding who can be covered by Medicaid and second, by providing public insurance exchanges.
A significant political challenge to the ACA has come in the form of a ruling by the Supreme Court allowing states to opt out of the Medicaid expansion portion of the plan. Currently, about half of the states, including Wisconsin, have opted not to expand Medicaid coverage, claiming it’s too expensive. Medicaid is a federally funded program managed independently by each state. Under the ACA, the federal government has agreed to fund qualified citizens newly enrolled in Medicaid at 100 percent until 2016, at which time federal funding will taper off and states would be expected to pick up some portion of the funding.
Even if a state agrees to expand Medicaid coverage now, it can opt out at any time down the road, which left Peterson wondering why Wisconsin wouldn’t at least take advantage of the opportunity for the next couple years.
The insurance exchanges accomplish expanded access to insurance by providing subsidies and tax benefits to help people pay for their insurance. The federal government has defined what services must be covered and what levels of insurance must be provided by insurance companies through the exchanges. Citizens cannot be denied coverage. States can create their own exchange, such as Minnesota has done with Minnesota Care, or participate in the federal exchange, as Wisconsin has chosen to do, at healthcare.gov.
Plans range from catastrophic to cadillac coverage. The availability of subsidies and tax credits to help pay for coverage depends on where an individual or family’s income fits on a scale of 138 percent to 400 percent of the poverty level.
“We have a policy that fits with our political reality. It is truly remarkable that we have the ACA. Once folks see the benefits, they will say how can we imagine not having these types of benefits for all Americans,” Peterson said.
Local public libraries are required to provide information and resources to help citizens understand and access the ACA, although they are prohibited from directly helping people decide which plan is best for them or actually filling out applications for people.
“Most of our effort has gone into putting resources on our web page (NewRichmondLibrary.org). To find information about the ACA, look under Quick Links and click on Research and you’ll see a link to the Affordable Care Act and General Health Information,” said New Richmond Public librarian, Paula Meisner.
The library is currently out of written materials regarding the ACA but Meisner said those materials are available online and can be printed on demand.
Library staff continue to undergo training to help them understand their responsibilities with regard to the ACA, but surprisingly, so far no one has come in asking for help.
“We’ve gotten ready for folks, but nobody has come in here yet to ask,” Meisner said.
Linda Skoglund, President of J. A. Counter & Associates, Inc., says her firm has been preparing clients for two years for the implications of the ACA.
“We’ve been gearing up for two years for this and trying to do everything we can to make it work, but anytime you roll out a change this monumental, it’s going to come with glitches,” Skoglund said.
People without insurance, small employers (50 employees or less) and individuals will feel the most impact from the ACA according to Skoglund.
“Individuals who had been eligible for BadgerCare or qualified for insurance under the Health Insurance Risk Sharing Pool (HIRSP) or were covered by an individual policy are going to the exchange to see if they are subsidy eligible. They’re looking to see what their rates are going to be. A number of those folks are going into rate shock,” Skoglund said.
Skoglund’s biggest fear is that people who are currently insured, when faced with a 70 percent premium increase are going to ask themselves, “Am I going to stay insured or am I just going to risk it and go uninsured and pay the penalty?”
That illustrates one of the critical challenges the ACA faces according to Skoglund. While the ACA theoretically makes insurance available to scores of people who have never been insured, it does so to some degree on the financial backs of many people and employers who are currently insured by raising their rates, at least in the short run.
In Wisconsin, Skoglund estimates that 70,000 - 90,000 people currently insured under HIRSP will be forced to find insurance on the exchange when the HIRSP is discontinued beginning in 2014. Expanded Medicaid coverage will not be an option in Wisconsin.
“So many parts of this law are good and super positive for our country. But you have to be careful what you ask for because there is a price tag associated with it. I don’t think people fully understand the (financial) impact of this law,” Skoglund said.
Editor's note: A previous version of this article misidentified Bev Peterson and Dr. Lon Peterson.