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October 1: Countdown to Obamacare - TV Smart Talk

Written by Nell McCormack Abom | Sep 11, 2013 10:00 AM

Smart Talk returns Thursday night at 8 for the first of the final five programs of the series. Be sure to join us this week as we focus on the October 1 launch of health-insurance exchanges under the Patient Protection and Affordable Care Act,a.k.a. Obamacare.


Gov. Tom Corbett opted not to create a state-run exchange so the federal government will operate Pennsylvania’s online marketplace. Starting next month, consumers who lack health insurance will be able to compare and contrast plans from health-insurance companies that choose to participate in the exchange. Do you have a question or a comment about Obamacare? Please join the conversation Thursday night. Call 1-800-729-7532, email, tweet, post a comment below or to Facebook.

The Washington Post correspondent and National Public Radio commentator T. R. Reid will be our guest. He has updated his 2009 book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, with an explanation of Obamacare.


The book chronicles Reid’s visits to five countries searching for a cure for both a decades-old shoulder injury and what ails America’s health-care system. His findings are surprising (Indian herbal ointments, massage and Hindu prayers seemed best to heal his aching shoulder) and somewhat alarming. As Reid notes, studies estimate that nearly 45,000 Americans who cannot afford to see a doctor die each year.

At its root, Reid argues, our government's failure to make health care a moral imperative yields tragic results. “It’s a national problem – a national scandal, really - that is undermining the physical and fiscal health of every American,” Reid says. After visiting and studying the health-care models in Canada, France, Germany, India, and Japan, he finds “Countries that are just as committed as we are to equal opportunity, individual liberty, and the free market have concluded that everybody has a right to health care – and they provide it. One result is that most rich countries have better national health statistics – longer life expectancy, lower infant mortality, better recovery rates from major diseases – than the United States does. Yet all the other rich countries spend far less on health care than the United States does.”

The legislation that creates Obamacare is massive – some 406,000 words. It already has brought significant changes to the American health care system and caused some companies to trim their benefits. The goal of the law is to drive down the number of Americans without health insurance (50 million, the Congressional Budget Office estimated in 2010), improve health outcomes, and cut costs. The CBO estimates Obamacare will reduce the number of uninsured Americans to 23 million by 2019. How? About 16 million of the uninsured will enroll in a more expansive Medicaid program and another 16 million will be covered by private insurers. Gov. Corbett has not yet chosen to expand Medicaid despite heavy pressure from Democratic lawmakers and even some fellow Republicans. Momentum for expansion might have grown and there are indications Corbett will have an announcement about Medicaid next week.

Each exchange will offer buyers five levels of health-care coverage from “Bronze,” through “Platinum,” to “Catastrophic” with price-tags to match the offerings. We don’t know yet how much the plans will cost but two studies released last week give a hint. There will be federal tax credits to help families afford a package. Families with incomes up to $88,000 could qualify for a credit. Private employers with more than 50 workers won a one-year delay in having to offer employees coverage. Smaller companies already can benefit from a tax credit for offering health insurance.

Starting in 2014, you cannot be denied coverage for a pre-existing condition. Insurance companies no longer will be able to set annual or lifetime limits on reimbursements. And, insurers must keep their administrative costs to 20 percent of the premium income for most plans. Insurance companies still can deny claims and they can take their grand old time paying a claim. How are we paying for this massive law? Taxes. Drug makers, medical-device companies, health insurers, even tanning salons face new taxes and fees to help pay the estimated first-decade $940 billion cost of Obamacare. Wealthy Americans will chip in more in Medicare taxes and Uncle Sam will hit up their financial earnings, too. Cost controls could be on the way, as well. Obamacare creates a new federal agency to recommend how much Medicare will pay physicians and health systems for each medical procedure.

Our other guests include Dr. Matthew Howie, a family physician and medical director of the York Hospital Community Health Center. “We are geared toward the medically underserved,” Dr Howie says. “So, these are individuals who are on Medicaid, are underinsured or who have no insurance. And we also have a number of low-income folks who are on Medicare.” Several partners in the medical community in York devised a process to identify people with gaps in coverage and to offer them discounted services. For the patients Dr. Howie treats, Obamacare is a lifeline. “My personal belief is that the ultimate goal should be universal coverage and there’s lots of reasons why that makes financial sense as well as medical and ethical sense,” he argues.

Christine Amy also will join us. She is a self-described community organizer and project director of Aligning Forces for Quality in South Central Pennsylvania. It’s part of the Healthy York County Coalition and began in 2007 through a grant from the Robert Wood Johnson Foundation. Amy says AF4Q takes a very patient-centered approach to medical care. “Health care at the national level is in crisis. It takes local people working together from a multi-stakeholder basis, such as the doctors and nurses that give care in the hospitals have to work with patients, but also with the people paying for the care – the employers and the health plans,” Amy says.

Since 2007, her group has worked with those stakeholders to close the gaps in health care in York. “The way we pay for care is a big problem,” Amy explains. “We pay for quantity of care not quality of care. And that’s caused by your health care benefit plan which is managed by your employer or your health plan. It’s not really managing the relationship between you as a patient and your health care. It’s about getting a bill paid.” AF4Q took the first step to more patient-focused care by publicly reporting data from doctors. They uploaded information about local health treatment and outcomes on their website to better engage consumers/patients about their options for care. Amy would like to see Obamacare prompt a wholesale revision in America’s approach to medical care. “We don’t help people to do the things they need to do to get better,” she reasons. “We pay for someone to have a heart attack but we don’t pay for wellness, eating right, exercising, understanding their condition and how to self-manage their care. We pay for catastrophic events and then wonder why our health care system is going bankrupt.”

Be sure to join the conversation Thursday night at 8!

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