Experts Try to Clear Up Confusion About Insurance Reforms

Andrew Kitchenman | November 13, 2013 | Health Care
In presentation at Richard Stockton College, a lesson in the ACA and the shifting landscape of healthcare

State Sen. Jim Whelan, AtlantiCare Health Solutions Senior Vice President Steven Blumberg, Justine Cesarano of Enroll America and Dr. Jaime Torres of the U.S. Department of Health and Human Service take part in yesterday's forum on insurance and healthcare reforms.
The federal health insurance marketplace has had a stumbling start, but a senior federal health official and other healthcare experts are trying to make a case for why it will still provide benefits to meet a variety of healthcare needs.

Dr. Jaime Torres, regional administrator for the U.S. Department of Health and Human Services, yesterday told an audience of students and local residents at Richard Stockton College of New Jersey that the country was badly in need of the Affordable Care Act, the 2010 law intended to expand healthcare access and reduce growth in health costs.

College officials said the event — attended by roughly 400 people – was aimed at providing clear information about the ACA.

Torres acknowledged that there have been problems enrolling in insurance through the marketplace website, He added that the site is “improving,” and noted that people can bypass the website and begin the application process by mail or by phone.

Torres said the ACA sought to address a variety of flaws in the U.S. healthcare system, including the existence of 50 million uninsured residents nationwide, high medical costs that frequently contribute to bankruptcy, and a lack of coordination and communication between healthcare providers.

“There was a huge health crisis,” he said.

He added that the law has already made an impact, although many of its key provisions don’t go into effect until January 1, 2014.

The law has allowed 3.1 million Americans under 26 years old to be covered by their parents’ insurance, Torres noted, and led to New Jersey insurers having to pay out $10 million to residents because the companies exceeded new federal limits on non-medical expenses.

It has also saved seniors an average of $706 on prescription drugs in 2012 through new discounts that drugmakers agreed to under the provisions of the law, Torres added.

Torres also said that an ACA provision funding Medicare accountable care organizations (ACOs) will increase coordination among healthcare providers. He said his father, who died from diabetes complications three years ago, was once prescribed a medication that could have killed him when the prescribing doctor should have known from other doctors that it would be harmful. Torres likened the healthcare system to the biblical Tower of Babel: “There isn’t enough coordination and communication.”

AtlantiCare Health Solutions Senior Vice President Steven Blumberg added that ACOs are designed to increase accountability, by making more of providers’ pay dependent on providing care efficiently and by tracking the health of the residents that the ACO provides care for. AtlantiCare, which operates hospitals in Atlantic City and Galloway, has formed a Medicare ACO that Blumberg leads.

Sen. Jim Whelan (D-Atlantic), a member of the Senate Health, Human Services and Senior Citizens Committee, noted that the United States has the highest healthcare costs in the world, but that outcomes are worse than in other developed countries.

He said it was difficult for Congress to change the system, considering the amount that healthcare industries spend on lobbying.

“That’s part of why we have the most expensive and least efficient healthcare system in the developed world,” Whelan said.

In a point that resonated with college-age audience members, Justine Cesarano, state director of the nonprofit Enroll America, noted that many young people are insured by their parents due to the ACA.

Some of the audience questions reflected skepticism toward the law. In response to a question about whether the law was “socialist,” Cesarano said that people were already picking up the tab for health expenses of the uninsured. through charity care, which compensates hospitals for treating the uninsured.

Whelan added: “This can’t be a nation of free-for-all and anarchy … these were the same arguments used against Social Security” and child-labor laws.

Torres responded to a question about why it doesn’t make more sense to pay the annual penalty for violating the new federal health insurance mandate, rather than to pay for more expansive monthly insurance premiums. The penalty will be the greater of $95 or 1 percent of income in 2014, rising to the greater of $695 or 2.5 percent of income in 2016.

“It is a little bit shortsighted,” Torres said, noting that a three-day hospital stay averages $30,000. “The day you need it the most is the moment that you start having second thoughts” about not having insurance.

The audience drew many people who were unsure about the ACA’s details, as well as students required to attend the talk for their classes.

Egg Harbor Township resident Sondra Harper, a security guard at an Atlantic City casino, said she’s looking for insurance that provides better coverage than her current employer-provided plan. But she and her husband Alan Harper were apprehensive when looking at the potential premium costs, which were three to four times higher than her current monthly premium.

Eagleswood Township resident Joette Dodds, a vocational rehabilitation counselor, said she works with vision-impaired people who can have difficulty finding doctors who accept their current insurance. She is looking to refer them to the marketplace health plans, adding that the event was informative.

Other residents said the ACA wouldn’t benefit them.

Galloway Township resident Rich Darling, a truck driver, said he came to the event “to see how many dupes there are that follow this nonsense. It looks like there are a whole roomful.”

Darling goes without insurance, saying that his health plan is to “eat right, get enough sleep and get exercise.” He said he wouldn’t seek medical treatment: “I don’t get sick. I don’t have time for it and I don’t intend to. I don’t know why I’d get sick.”