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ON THE SCENE: Bracing for a big jolt in America’s health care system

January 12, 2017
By NAJ WIKOFF , Lake Placid News

Changes are coming to healthcare. Unless you are very wealthy, work for a company that covers your health care costs, or are a member of Congress, whatever changes are made to the Affordable Care Act will result in higher costs and less coverage.

This is not to say that the Affordable Care Act is perfect, far from it, but according to Henrietta Jordan in her presentation, "Unpacking the Changes in Healthcare Insurance" given at the Keene Valley Library Monday, Jan. 9, we should expect a big jolt.

Jordan is a policy wonk. Before moving to Keene Valley in 2002, she had a wide-ranging career in human services during the time when Vermont's Gov. Madeleine Kunin and state legislature created the groundbreaking universal health care program for children, "Dr. Dynasaur" and later when the state enacted a comprehensive Universal Health Care Act under Gov. Howard Dean in 1992.

Article Photos

Henrietta Jordan
(Provided photo — Naj Wikoff)

That experience provided her a foundation in the nuances of the Affordable Care Act as it evolved.

"I followed the enactment of the Affordable Care Act very closely," said Jordan. "My prior work in Vermont helped me understand how the various components supported each other and why, for example, the law needs to require universal participation (individual and employer mandates) to ensure community rating and guaranteed issue."

Jordan started by asking if anyone in the audience felt they were paying too little for their health insurance? No takers. Nor did anyone think that health care costs (what doctors and hospitals charge for care and drug companies charge for pharmaceuticals) would go down, or that Americans have the best health care system in the world; though, many do, if cost is not an issue. Her final question was, "Should health care be a right or a privilege?" Everyone agreed it should be a right. By that, people felt if something bad happens any American should be able to see a doctor or go to a hospital and get quality care.

Remember when health insurance companies could refuse to cover pre-existing conditions or certain health care expenses such as mammograms and child birth? Jordan went through a list of horrific aspects of health insurance before the Affordable Care Act which included premium increases annually outstripping the rate of inflation and those without health insurance flooding emergency rooms knowing they wouldn't be turned away. She pointed out that, according to the Kaiser Family Foundation, there are now over 52 million people with insurance that previously would have been deemed "uninsurable," 3,031,000 in New York state - 25 percent of non-elderly adults.

Jordan then drilled into what people like about the Affordable Care Act, and what they didn't like, such as healthy people don't like to be required to have health insurance. The logic, though, like requiring all car owners to have auto insurance, is that such requirements spread the cost of care across a wide swath of people and foster support for laws that improve health and safety.

By the same token, mandating health insurance helps reduce the average cost of premiums, provides the funding to people with pre-existing conditions, and enables young people to stay on their parents' policy until age 26. Also, it incentivizes people to engage in preventive health care behaviors and medical centers to become more focused on keeping the general population well in the first place. The reality is that much of the cost of health care addresses chronic care, a high percentage of which can be prevented or radically diminished through diet, exercise and reducing the use of tobacco, alcohol and other drugs, opiates in particular.

Another driver of the high cost of health care in the U.S. is our multiple-payer health system that's resulted in high administrative costs and a weakened ability to negotiate with pharmaceutical companies to reduce the cost of drugs. As an example, in the United States, administration accounts for 25 percent of hospital spending while in Canada, their administration cost is 12 percent, and in England it's 16 percent. The big difference is they have a single-payer system and we don't. If we could cut our rate in half to equal Canada, we'd save more than $100 billion annually.

Jordan discussed changes proposed by President-elect Donald Trump and the Republican Congress that included refundable tax credits, expanding the use of private savings account, allowing insurance companies to charge older and high-risk patients more (the people on average with the least ability to pay), enabling companies to self-insure, tort reform and the like. The challenge is that Republicans have not yet proposed an alternative plan, and repealing the Affordable Care Act without an alternative plan in place creates uncertainty, which neither the insurance industry nor hospital administrations like.

"We're expecting a lot of change," Adirondack Health CEO Sylvia Getman said the previous day. "We in positions of leadership have been talking about how we are in an era of unprecedented change, and that was before the election. The move from volume-based to value-based care and the move to real prevention-based services are well underway. The fear in the health care industry is the repeal of the Affordable Care Act may disrupt what we feel is a very necessary transformation of our industry. Also, the disruption could make our industry less manageable. For us, unpredictability is troubling as predictability provides a stable landscape to provide care in if the rules keep changing its harder for us especially as we are a very regulated industry."

"Your health care system and the proposed changes seems totally wild and irrational," said Steve Wyatt, a Canadian speaking after Jordan's presentation. "In Canada, people are wondering why the Republicans are dismantling Obamacare. It seems they want to put all the responsibility for health into the hands on those most disadvantaged."

"I found Henrietta's presentation extremely informative," said Mary Lawrence. "I'm glad I came. It was a lot to absorb. Huge. I wish we had more time to discuss the proposed Medicare changes."

"I think she did an extraordinary job of setting the stage of what we have and what have the potential of losing without losing track that the status quo isn't perfect," said Lesley Shipps. "It has gotten me more fired up to show up and speak up. We don't want to step back."

Jordan created a 14-page summary of her research, which will be available on the Keene Valley Library website, and plans to make future presentations. She cautions that people should expect more changes, encourages them to learn all they can and to share their concerns and desires with Congresswoman Elise Stefanik, R-Willsboro, and U.S. Senators Kirsten Gillibrand (D-New York) and Chuck Schumer (D-New York).

"We have to take responsibility for the future of our healthcare system," said Jordan.

Of note, Adirondack Health's investment in a planned medical health and fitness center in Lake Placid underscores that good health and access to quality healthcare requires a partnership between people, their doctors, medical centers, and community health agencies.



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