Some changes to the health care industry will stand no matter who becomes president, according to a panel of experts in Colorado Springs last week for the Colorado Rural Health Center.
“It doesn’t matter what it’s called,” said Michael McNeely, deputy director of the hospital-state division of the Office of Rural Health Policy. “Call it the Affordable Care Act, call it ObamaCare, call it something else. There are enhanced rules from the law that will remain.”
Some of those will be readily apparent, he said. Doctors and hospitals across the country know that they’ll no longer be able to bill based on the volume of patients, he said. Instead, payments will be bundled and given to doctors, hospitals and specialists based on outcomes.
“Primary care has to be integrated,” McNeely said. “And we’re all going to have to know where we’re going, how to work together. The government isn’t going to pay based on volume; they’re going to look at what you’re doing, how effective you are at providing care.”
Health care experts are confident that bundled payments will remain no matter what happens to the Affordable Care Act, which presidential candidate Mitt Romney has promised to overturn if elected. The individual mandate — requiring everyone to have insurance — is very unpopular in some political circles and was challenged in the courts. The Supreme Court ruled this year that the mandate is constitutional, and must remain in place.
In light of ever-rising health care costs, hospitals must try to provide value to patients through providing higher-quality care at lower prices, he said.
“The quality can’t suffer, so the only thing that’s going to get us there is to reduce costs,” he said. “No one wants hospitals to close, so we need to have smart practices. There has to be a partnership with patients, and patients have to take some responsibility for their health care.”
Health benefit exchanges
Colorado’s Health Benefit Exchange is one — and probably the largest — of the parts of the Patient Protection and Affordable Care Act that will remain. That’s largely because it’s codified in state law, and has to be financially independent by 2016. The state’s new health benefits exchange will not rely on federal money or federal law to remain active.
The exchanges work like online travel companies Expedia and Travelocity, said Patty Fontneau, executive director and CEO of the Colorado Health Benefit Exchange. Consumers can compare insurance prices and plans to choose the one that fits them best.
Because health care is more complicated than airline travel, so is the exchange, she said. And so she is crossing the state, dispelling myths about what the exchanges can do.
“We’re not a purchaser of insurance,” she said. “If carriers meet the certification process, then they can sell products on the exchange. We’re not going to create adverse selection in the marketplace. As long as the carrier can sell insurance in Colorado, they can sell it on the exchange.”
Insurance companies will have to provide several broad categories of care to be able to sell in the exchange, and only certain types of individuals and businesses can buy insurance on the exchange.
“For instance, businesses with 50 or fewer employees can buy on the exchange in 2013,” she said. “But if you are with a company larger than 100 people that offers insurance, you can’t buy individual insurance on the exchange.”
Designed to ease the cost burden of insurance for small businesses and individuals whose companies don’t provide insurance, the federal government will provide subsidies for insurance premiums. Families of four who make around $92,000 can get part of their insurance premium paid for by the federal government, she said. For families who make 133 percent of the federal poverty level (or less), the federal government will pay half their premiums.
It’s not a tax credit to get back later, Fontneau explained. Instead, the federal government will send the money for the premium directly to the insurance company.
“It’s a credit you get right then, because you only have to pay your share,” she said.
The exchange isn’t part of the Medicaid system, nor will it take money from the state. Fontneau said she wasn’t sure how the exchange would pay for itself, but that would be tackled in the next two years.
No matter who is president, cost will remain a major health care issue. The ACA is designed to lower costs, but that will only occur over time, said Alicia Haywood, policy and advocacy manager for the Colorado Rural Health Center.
“Several things will pressure prices to go up,” Fontneau said. “And the cost of insurance isn’t going to go down. Guaranteed issuance starts in 2014; you can’t be turned down for insurance. In addition, you can’t be rated based on pre-existing conditions. Both of those are going to pressure prices to go up.”
Even forcing insurance companies to provide specific benefits in plans will drive up costs, she said.
“But the individual mandate, that’s going to bring prices down,” she said. “We’re counting on the people between 20 and 30 — the ‘young invincibles’ who are healthy and don’t have insurance — to drive down prices.”
Spreading the risk among millions of people will also drive down costs, she said.
“But the markets have to stabilize,” Haywood said. “But macro economics said that we’ll bend the cost curve through the marketplace, through the exchanges, where people can shop with side-by-side information.”
Fontneau again compares health care reform costs to those of the airline industry.
“I think we can argue that Travelocity and Expedia have held the price of an airline ticket steady, if not made it cheaper,” she said. “That’s what the health insurance reform — it really isn’t health care reform — will do, I think.”
Of course, what remains in place of the Affordable Care Act depends on who is president and what happens with Medicaid expansion, part of the ACA that the Supreme Court said over-reached the federal government’s powers.
“We’ve been told that we’ll know what happens in Colorado very soon after the election,” Haywood said. “Understandably, providers want to know if Medicaid is getting expanded to the levels asked for in the federal legislation. All we can say at this point is that we’ll know after the election.”