Niagara Gazette

November 4, 2012

REFORM: Getting to the heart of health care

By Michele DeLuca
Niagara Gazette

Niagara Gazette — IF YOU GO

WHAT: Health Care Reform Panel Discussion WHEN: 6 p.m. Nov. 14 WHERE: Niagara Falls High School Performing Arts Center, 4455 Porter Road, Niagara Falls FOR MORE INFO: Contact Niagara Falls Memorial Medical Center at 278-4569.


It would be interesting to see a show of hands right now.  

Who hasn't gone to the doctor lately because they can't afford the co-pay?  Who is horrified at the rise in the cost of their medical insurance?  Who understands health care reform?

For those of you who dropped your hand at that last question, you are not alone.  Health care reform seems as complex as brain surgery. But the goals of it are as simple as the healthy blush on a child's cheek.

On Tuesday, a lot of American voters are going to be standing in a voting booth, deciding who they want to lead our country for the next four years. Many will be deeply concerned about the matters of their health. And if they are confused about which way the country is heading on matters of health care, they are in good company.

Recently, a group of local health care experts shared their opinions about "Obamacare,"  as the Affordable Care Act is being called. The experts agree that the most important thing that citizens need to know is that nobody really knows for sure how health care reform is going to happen, but they all agree that health care must be reformed.

Even if Mitt Romney wins the presidency and tries to repeal the act, according to some experts, he'll have trouble changing some parts of it, especially the provisions that allow children to remain under their parent's coverage until they are 26 years old.  In this economic market that provides an important safety net for our young people.  

Another popular provision of "Obamacare," is that health coverage cannot be denied if a person has pre-existing conditions. That just makes sense to people, much like agreeing to not hit a man when he's down. 

The act is now law, so a dead stop is almost impossible, according to Roberta Rifkin, vice president of government affairs for Independent Health.

"What the bill does do is create an environment for change, " Rifkin said and others agreed.

"This is both an evolution and a revolution," said John Bartimole, president of the WNY Healthcare Association, a trade organization representing area hospitals.

"Obamacare" as it stands is very open ended right now, according to Bartimole, a lobbyist for his association. The bill is created so a lot of the ultimate decision making power on many of its provisions is ultimately charged to the Secretary of Health and that person will serve at the wishes of the new president. Many of the provisions won't come into effect for two years, so there is much jockeying taking place in the details.

"The federal government and the state government are still developing the rules," said Don Ingalls, vice president, state and federal relations for BlueCross/BlueShield of WNY.  "We don't have all the details we need."

The crux of reform involves creating a healthier population and getting and keeping people healthy.  "Obamacare" has numerous incentives to encourage municipalities and businesses to enhance the health of their people through programs that promote nutrition, exercise and preventative care.

The second most important issue is cutting costs by insuring the nearly 50 million uninsured who use hospital emergency rooms for their primary care — resulting in very expensive hospital bills, which ultimately raise the premiums of the insured.

What seems to be upsetting some voters is what is called the "individual mandate," which requires everyone to have health insurance or pay a penalty. However, the crux of the mandate is that its better for everybody if everybody has insurance, according to Ingalls of BlueCross/BlueSheild. "If we get everybody covered there's a good balance of younger people and older people and that helps keep premiums more affordable."

Ruffolo, whose hospital is sponsoring a panel discussion on health care reform Nov. 14 (see box) was asked whether he thought "Obamacare" was good or bad.  "It all depends on who you are," he said. Hospitals are already being tested by the Medicare Reform Act which rewards hospitals for patient satisfaction and clinical quality and penalizes hospitals with less reimbursement when there are higher than expected readmission rates. "Obamacare" also reduces the amount it will reimburse hospitals for treatment to unisured, he said.

"I think our hospital is going to be negatively impacted by lower medicare payments, further than what we will recoup with more people getting insurance," Ruffolo said.

"But, we have to adapt to the change," he added. "It is what it is."

Also impacted will be small businesses, who in 2014 will have to provide health insurance for all their employees. One expert speculated that such laws would force business to keep their employee numbers low to avoid penalities inflicted upon larger employers.

"The smaller of a company you are, the higher percentage of tax subsidy or tax credit you'll receive," said Don Ingalls, vice president for state and federal relations at BlueCross/BlueShield.

Experts interviewed seem to agree that state-based "health care exchanges," where customers can pick and choose their plans, will make health care industry much more competitive, resulting in better packages for the consumer. 

No law can fix everything, but the experts agreed that change is vital.  And, many health care providers and insurers are already trying to improve services and cut costs. Independent health has started doing that through their P-2 Collaberative, with P-2 being short for "Pursuing Perfection,"  joining with Univera and Blue Cross and Blue Shield, along with other area medical providers to create an environment for change. 

"We know we have to look at reducing costs," said Rifkin of Independent Health, who estimates her company spends 90 cents to the dollar on patient health care bills. "If that's where the bulk of our costs are, how do we reduce those costs so premiums don't keep rising."

In an effort to cut cost of treating the underinsured, Niagara Falls Memorial was recently named a "Health Home," for Niagara County, which will allow the hospital staff to literally caretake those patients who overuse hospital services, assisting them outside of the hospital with all manner of life improvement issues from housing to social services, and working to keep them well.

"The name of the game is going to be how to keep people out of hospital," said Joe Ruffolo, president of Niagara Falls Memorial Medical Center.  "Medicare at its present rate is going bankrupt and theres no question that things need to be done so when I'm 65 I'll be able to have Medicare," he said. He's obviously not the only one worrying about health care being affordable as they age.

"I've become a psychologist," said Rifkin, when asked about the conversations she has out in the community about health care. "There's a lot of angst about what is going to happen."

While "Obamacare" will likely survive the election even if Obama does not, what stays and what goes will also depend on who runs the Senate, explained Ingalls, the hospital lobbyist. "I think the difference is Mitt Romney as a Replublican, is philosophically opposed to bigger government and opposes individual manadate. 

Clearly both the health care industry and the populace need to consider that change must come before Medicare, a healthcare safety net for most American, goes bankrupt.

"I think we have to stay focused on wants really important, creating a culture of health in our community and looking at improving care and reducing costs," she said. "That's really what reform really means — a better patient experience, better community health and lower costs."

Contact Features Editor Michele DeLuca at 282-2311, ext. 2263.



IF YOU GO WHAT: Health Care Reform Panel Discussion WHEN: 6 p.m. Nov. 14 WHERE: Niagara Falls High School Performing Arts Center, 4455 Porter Road, Niagara Falls FOR MORE INFO: Contact Niagara Falls Memorial Medical Center at o 278-4569.