The Affordable Care Act, a major part of which is about to be implemented, may be widely misunderstood and reviled by many.
But the Obama administration’s health-care reform law, sometimes called “Obamacare,” is “the law of the land” and is unlikely to undergo any significant revision in the immediate future, panelists said during the Center for Global Health and Medical Diplomacy’s 7th annual Caring Community Conference at the University of North Florida Wednesday.
Jason Altmire, now senior vice president of public policy, government and community affairs for Florida Blue, was a Democratic congressman from Pennsylvania when the Affordable Care Act was enacted in 2010. He ended up voting against the bill, largely because he said the administration of President Barack Obama, yielding to the wishes of interest groups like hospitals, physicians, pharmaceutical companies and the AARP, had “taken out everything that could reduce cost.”
He said the general attitude in Congress today is that no matter what the act’s flaws may be, “We don’t want to touch it.”
Democrats don’t want to reopen the debate, he said. “Republicans don’t want to fix the problems. They want people to feel the pain.”
Certainly people already feel the confusion.
Panelist Hugh Greene, CEO of Baptist Health — introduced by moderator Steve Halverson as someone who, unlike members of Congress, has actually read the bill — noted there has been “huge misunderstanding and a lot of hyperbole about this law.”
“There’s been so much confusion, so much misstatement,” said Yank Coble, director of the Center for Global Health and Medical Diplomacy. “There is paranoia and mistrust about this legislation.”
A recent poll by the Kaiser Foundation found that 40 percent of Americans are still unaware that the law remains on the books and a major part of it is about to be implemented. It also found that 49 percent of those who know that there is an Affordable Care Act don’t know what the law says.
Next month, insurance exchanges are supposed to open in each state where uninsured residents can shop online for coverage. That coverage will go into effect Jan. 1. The Affordable Care Act called for the states to set up the exchanges but many states in the South and West, including Florida, chose not to set up the exchanges. So in Florida, the new exchange will be operated by the federal government.
Florida was also one of many states that declined to expand Medicaid coverage to a group with income between the poverty line and 138 percent of the poverty line. Thus the state has passed, so far, on $50 billion of federal Medicaid dollars over the next 10 years. As a result 1.1 million Floridians are left without Medicaid coverage but don’t qualify for federal subsidies to buy policies through the exchanges.
That was the source of a good deal of unhappiness among several of the hospital administrators at Wednesday’s conference.
“It will be tragic if the state continues to allow this money to go out of state,” said Daniel Wilson, vice president for health affairs & dean of the University of Florida College of Medicine in Jacksonville.
Greene said a lobbying effort must be continued to convince the Legislature to accept the federal money and extend Medicaid coverage. But State Sen. Aaron Bean, who accompanied Gov. Rick Scott on a brief stop at the conference, said, “Unless there is a spark to move the sides off of their starting points, I don’t see things changing.”
The plight of “safety net” hospitals like UF Health Jacksonville (formerly Shands Jacksonville) was the subject of its own panel. Wilson said that with 50 percent of UF Health Jacksonville’s patient load taken up by Medicaid patients, on whom the hospital is fortunate to break even, and uninsured patients, whose cost of care the hospital absorbs, UF Health is now in a position “that is not sustainable.”
UF Health lost $30 million over the last two years, Wilson said. Part of the problem, he said, is that for the last 12 years, the city has been paying $24 million a year to care for 10,000 of Jacksonville’s 145,000 uninsured residents. But the actual cost of that care has been increasing steadily, he said. Last year the hospital spent $60 million on those patients.
While the Affordable Care Act has flaws, Greene said it does some good things.
“We’re beginning to move toward payment system reform,” he said, noting that there are incentives to base reimbursement on the quality of care rather than the volume of care, an approach sometimes called bundled care.
“There is a lot of incentive for us to improve care through bundled care,” said Moody Chisholm, CEO of St. Vincent’s HealthCare. “It creates a lot of innovative thought.”
“This transition process is going to be tough,” Greene said. “But this is the law of the land. This law is not going away.”