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Expert talks health care reform

Article Published: May. 27, 2010 | Modified: Sep. 7, 2011
Expert talks health care reform

Adam Linker of the N.C. Justice Center says national health reform will pay for the uninsured upfront instead of figuring out how the bills should be paid after care is given.

Photo by Scott Nicholson

What does the new national health insurance plan mean to you?

That depends, Adam Linker told a crowd of local health officials and business owners last Friday.
Linker, a health policy analyst with the N.C. Justice Center, said while a few provisions of the plan had already taken effect, others won't kick in until 2014 or later.

Linker also characterized the plan as more of an "upfront" payment system, saying those without insurance already had much of their health care covered by different programs, though hospitals also wrote off millions of dollars in unpaid bills each year.

Linker said the N.C. Justice Center worked with the state government, advocating for "fair treatment and economic security as ways to end poverty."

He also said the state now had a role in developing a consumer coalition to administer some aspects of federal health reform.

"It's easy to get negative or positive views (of health care reform)," Linker said. "I don't think any of us have seen a perfect bill come out of Raleigh or Washington."

Linker said many people will still be getting their insurance at work, but tax credits will create more incentives for small businesses to offer insurance or offset some of the cost. Health reform also immediately protects children from being dropped from insurance because of pre-existing conditions, and also allows young people to stay on their parents' health insurance until age 26.

"Reform will not drastically change the way people pay for health care or where they get their health care," Linker said. "It's building on the current system."

He also said the current range of public health offerings will still have a role, including free clinics like the Health & Hunger Coalition's clinic in Boone. It will also change the way patients are treated when seeking health care, because the payments will be designated in certain areas, removing some of the uncertainty of health-care providers.

"The presumption will be that everyone has insurance," Linker said. "It is much more about how people fit (in different payment methods)."

Other immediate effects of the health plan are that insurance companies must spend at least 85 percent of premium dollars in the "large group market" and 80 percent of premiums in the individual and "small group markets." Linker said part of the state's decision will be in how to group people or whether to establish larger insurance pools by joining with other states.

The legislation also bars insurance companies from placing caps on lifetime benefits and creates a temporary high-risk pool for those unable to purchase insurance. Those in the new pool will spend up to $5,950 per person or $11,900 per family for coverage.

The legislation also seeks to expand health coverage by offering a 10 percent bonus payment through Medicare billing for physicians practicing in underserved or rural areas. It also provides $11 billion in funding for community health centers and clinics.

By 2014, states will have to establish a "health-insurance exchange," with some federal subsidies based on the poverty level and some tax credits advanced to pay for insurance premiums.

Medicaid will be expanded to everyone up to 133 percent of federal poverty level, Linker said.
"Hospitals do millions and millions in free care," he said. "The presumptive level for Medicaid will help the hospitals' bottom line.

"It's a true safety net for insurance at a certain level. Everyone is going to qualify for some type of insurance."

Though people can't be denied coverage because of pre-existing conditions, there are some escalators that can increase a person's premiums, such as whether they smoke or for aging. However, those premium charges will be capped.

Linker said the plan is projected to reduce the federal deficit in 10 years "primarily not because it brings down the overall cost of care but it raises new money to offset the cost, such as savings in Medicaid and Medicare."

Linker also said money would be going to preventive programs and wellness, though there are still some definitions to be determined, such as the extent of dental care. The plan also brings more attention to Medicare fraud, and Linker predicted it would build on the current state employee's health system and make it more affordable for state employees to put their dependents on the plan.

"Uninsured people delay care but eventually go get care," Linker said. "We're not adding people who weren't getting care. We're just financing it up front and making new investments in new doctors and trying to get them in rural areas."

Businesses benefit by getting tax credits of up to 35 percent if they have fewer than 25 employees and pay at least half the cost of their coverage. Businesses may also be able to join exchanges to create a larger pool with other businesses.

Linker's presentation was co-sponsored by the Watauga County Healthy Carolinians and the Appalachian District Health Department.

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