Support for Health Policy has been complicated by political rhetoric and the general public’s lack of knowledge about the Affordable Care Act, according to officials who spoke at last week’s AHCJ Chicago chapter meeting.
Chiquita Brooks-LaSure, the director of coverage policy in the Office of Health Policy in the U.S. Department of Health and Human Services, pointed out that Health Policy is critical to the nation’s economy. People are making decisions about their jobs because their access to health care is tied to their employment, potentially deterring people who want to start new businesses, she said.
Michael McRaith, director of the Illinois Department of Insurance, agrees. “We forgo our ambition, our entrepreneurial spirit, we ignore our talent because we need a group health plan to cover ourselves or our spouse or our child,” he said.
Twenty-five journalists and students gathered at Columbia College Chicago for the discussion of the health care overhaul as the law nears its first anniversary. Bruce Japsen, a Chicago Tribune health care reporter, moderated the panel.
When asked what the biggest myth about Health Policy is, McRaith singled out the individual mandate and proceeded to explain why healthy people have to buy coverage: If people only buy insurance after they get sick or injured, insurance becomes so expensive that no one can afford it. He described the mandate as “an essential component” that preserves the private insurance market and stabilizes the risk pool.
The country’s health care system, before passage of the Affordable Care Act, was broken, according to McRaith. He explained that, in Illinois, people can be denied insurance coverage for any reason except race, color, religion or national origin. He told of one woman who was denied insurance coverage because she attended grief counseling at a church after her 43-year-old husband died.
“In Illinois, even grief is a pre-existing condition.”
Attendees also heard from William Santulli, chief operating officer for Advocate Health Care, the state’s largest health care system. He described this as an “exciting time to be involved with health care delivery” and that his company is looking forward to the system’s transition from fee-for-service to fee-for-value. As he described it and health journalists well know, health care providers are paid based on how much they do, how many tests they run, how many procedures they perform, etc. But with reform, Santulli expects providers will get paid for keeping people healthy and ensuring that patients are receiving the most appropriate care.
The panelists discussed the role of the accountable care organization model, which Brooks-LaSure described as making sure that when people get care from multiple providers, the care is more integrated. McRaith cautioned that, in some cases, they have seen ACOs being used as a way to contain costs “that has nothing to do with the quality of care or the delivery of medically necessary care. “
Advocate Health Care has partnered with Blue Cross. Santulli said ACOs create incentives for health care providers because hospitals potentially get extra payments or will share savings if the hospitals can outperform the market.
The panelists answered questions from the audience about whether Illinois can afford the expansion of Medicaid and whether the state might opt out. McRaith said Illinois will not opt out and that the cost of expansion is covered by the federal government until 2019. Brooks-LaSure reiterated that HHS is working with states to provide money for the expansion of coverage.
A good deal of time was spent talking about health insurance exchanges that the states will run. McRaith explained how most people would interact with exchanges, describing it as a way to buy health insurance online, in 15 minutes and without filling out multiple forms for different companies. He sees the exchanges as a benefit to smaller companies that don’t have human resources departments and the time to evaluate and choose employee health plans. According to McRaith, employers with 50 or fewer employees will be able to go to the same website and make a defined contribution on behalf of their employees. Then the employees go to the website and choose an insurance plan that meets their individual needs.
He said he has heard a lot of criticism over the wellness initiatives in the Affordable Care Act, mainly along the lines of healthy people being unhappy that they have to pay for programs aimed at people they think are not making good choices. McRaith said that attitude demonstrates to him that there is a lot of ignorance about what wellness means and that people need to understand how socioeconomic status and location affect wellness. He used the example of food deserts, saying that there are many neighborhoods in Chicago where the only place to get food is a convenience store. He said people need to understand that there are entire communities lacking the resources to eat the way they should eat.
Journalist Duncan Moore asked the panelists about the political “hysteria” that seems to surround the Affordable Care Act. Brooks-LaSure acknowledged that acceptance of the act will come with time and education, much as what happened when Social Security was enacted.
According to McRaith, who has been working with insurance officials from other states to write the regulations that will drive health care reform, there is plenty of rhetoric on the political level but on the more practical level there is an understanding that these reforms are essential.
Special thanks to Carla Johnson for organizing the panel and making the audio recording available to other AHCJ members.
