By By JONATHAN CLAYBORNE
Staff Writer
Somewhere, echoing amid all the bluster about health-care reform, is a submerged reality: what happens on the ground as the measure’s key provisions take effect?
That reality is complicated and multi-faceted, though some aspects of the congressionally approved program are immediately clear.
It’s expected that 94 percent of Americans will have health coverage once all of the provisions become effective.
Yet, some medical professionals wonder about the fate of the massive changes signed into law last month by President Barack Obama.
Money is an inevitable barrier to enacting every facet of a sweeping reform program that could cost an estimated $1 trillion, these medical professionals say.
And there is some question as to whether many of the changes called for in the new law will be felt on the ground by year’s end. Indeed, numerous chunks of the law can’t take hold for months or years — like an individual mandate to buy insurance or pay a fine, which starts in 2014; or an $11 billion increase in federal funding for community health centers beginning next year.
“There will be no changes in six months,” predicted Dr. Richard Young, a Washington physician.
Things don’t evolve that quickly in the medical field, Young advised.
Primary concerns
In talking about reform, Young referenced the angst that doctors harbor over “the unknown character of what American medicine will be in the future.”
He said this anxiety stems from increasing “government control over all aspects of medical care,” including the delivery of that care.
He said there is uncertainty about the role doctors will play in shaping future medical models.
“These things being said, should change occur?” Young asked.
“Yes,” he answered pointedly, nodding specifically to solutions that could help control the costs of medicine.
First, he did a little work on defining the problems.
“Health care is, just plainly, too expensive in all aspects,” Young stated. “There are numerous reasons why.”
He said it’s estimated that 30 million Americans are without health insurance.
(Some estimates are even higher. The National Coalition on Health Care has reported that approximately 46 million Americans did not have health insurance in 2007.)
One obstacle to change is that there aren’t enough primary-care providers to serve the millions of additional patients who could flood the system as a result of reform, Young said.
Then there’s the matter of health-insurance premiums.
Young said it’s almost cost-prohibitive for someone to purchase health insurance on the private market, outside of a group.
“I personally know of numerous hard-working individuals who have had to declare bankruptcy due to an outstanding medical bill,” he related.
Young added, “That is ludicrous. It shouldn’t happen.”
“Health-insurance companies often discriminate in facets of insurance,” excluding people with pre-existing conditions, Young noted.
“This is plainly not fair,” he said.
(The initiative to which Obama affixed his signature prohibits insurance providers from denying coverage based on pre-existing conditions beginning in 2014, the same year that all legal American citizens must start buying health insurance, with certain exceptions.)
Young advocated allowing residents to buy insurance across state lines.
“We don’t have a fair system right now,” he asserted.
Medical-malpractice insurance also needs to be addressed, he said.
“Mainly, this is due to the fact that much of the work in medicine — like repetitive (laboratory tests) — are just not necessary, but the tests’ need is driven by a physician’s worry about the possibility of a medical malpractice suit if certain things are not accomplished,” Young said.
Malpractice settlements drive up costs less than the fear of settlements, and that fear generates repeated tests and lab work, he indicated.
“It’s the fear of settlements,” he agreed, “and that’s what’s driving it in every area.”
One thing that is sure to be realized by reform is the creation of a computer network that will allow doctors and medical facilities to share necessary information about their patients, Young forecast.
The implementation of such a system is long overdue, he suggested.
In the trenches
While advocates of reform purport to have found answers to the issues Young and thousands of doctors have brought to light, some local medical providers aren’t sure what shape those answers will take.
“I don’t have anything concrete yet,” said the Rev. David Moore, chief executive officer of Metropolitan Community Health Services.
Metropolitan serves low- to moderate-income patients through Agape Community Health Clinic in Washington.
“Until I know what (reform) really does, I don’t know,” Moore said of the effects on Agape. “Hopefully, it’s going to mean better access. The only thing that I’ve heard for sure is that everyone will be eligible. There will be no more pre-existing formulas.”
A call seeking further information from the N.C. Department of Health Human Services was not immediately returned.
All in the game
Conventional wisdom dictates that the debate over how to refine or clarify reform could be moot if the Republicans gain a congressional majority in the fall.
Yet, some GOP leaders are hedging on a total repeal, adding that Obama would veto any attempt to pull the plug on reform through legislation.
Whatever the case, political analysts say the costly provisions approved by the U.S. House and Senate have energized the conservative tea party movement ahead of this year’s midterm elections.
National political reporters have been writing that the tea party’s effectiveness is still untested, implying it isn’t known how much influence these disparate rebels could wield at the polls.
The North Carolina Republican Party has called on N.C. Attorney General Roy Cooper to join a multi-state effort to stop reform through the courts, a move Cooper — a Democrat — has declined to make.
Some Democratic officials are hoping their base will draw inspiration from these and other GOP-driven assaults at a time when the left is failing to keep a grip on a national agenda.
In a Washington Daily News interview last week, N.C. Secretary of State Elaine Marshall was asked whether she feared a GOP takeover of Congress would result in rolling back reform.
The Democratic U.S. Senate candidate replied: “That’s why the people of North Carolina need to be tuned into this election to a higher degree than they are currently.”
Health-care reform timeline
By The Associated Press
What does reform do this year?
— Sets up a high-risk health insurance pool to provide affordable coverage for uninsured people with medical problems.
— Starting six months after enactment, requires all health insurance plans to maintain dependent coverage for children until they turn 26; prohibits insurers from denying coverage to children because of pre-existing health problems.
— Bars insurance companies from putting lifetime dollar limits on coverage, and canceling policies except for fraud.
— Provides tax credits to help small businesses with up to 25 employees get and keep coverage for their employees.
— Begins narrowing the Medicare prescription coverage gap by providing a $250 rebate to seniors in the gap, which starts this year once they have spent $2,830. It would be fully closed by 2020.
— Reduces projected Medicare payments to hospitals, home health agencies, nursing homes, hospices and other providers.
— Imposes 10-percent sales tax on indoor tanning.
Sources: House Energy and Commerce Committee; Kaiser Family Foundation