More on Dying for Care

8

THE CRITICS
‘The de facto insurance policy’

For the law to have a substantial effect on the American public, it will require the health care industry to change its focus and prioritize patients, said Joanne Singleton, chair of graduate studies and director of the Doctor of Nursing Practice program at Pace University.

“Medical doctors will have to reshape the concept of health care as we move into this new health system,” she said. “They have to learn that to change health care, they need to view the patient as a person and not as a disease.”

Although more people will have access to routine care, Singleton said the law will not necessarily lower people's chances of severe and long-term health problems.

To help limit serious conditions for patients, insurance companies will have to cover more services to help counter diseases, Singleton said. This may not be something insurance companies will want to cover.

In recent years, several insurance carriers have been unwilling to invest heavily in preventative services because they won't see the return on that investment if customers switch insurance, Singleton said.

The law may hit its first major stumbling block in October when Americans are expected to enroll in health plans and sign up for Medicaid. This has prompted officials from the state and federal government and community groups to create a strategy to get people covered, said Lois Uttley, director of Raising Women's Voices, which focuses on getting heath care access for women in New York.

“The public is unaware of the fact that this exchange is being created and that they will have these options,” Uttley said.

The state is preparing for a giant marketing campaign to reach the uninsured. Constantakes, the state exchange spokesman, said officials are building a campaign to reach people via television, print and mail.

Part of the challenge will be to convince people to go online and shop for plans on their own. This could be difficult for people who speak different languages or who don't understand how to sign up.

So the state has organized a program asking community organizations working directly with underserved populations to educate people. Those confused about their health care choices can get a one-on-one consultation.

“We are the troops on the ground trying to reach people,” said Nora Chaves, director of Community Health Advocates, one of the groups participating in the navigator program.

The group helps people find care in four different ways: Medicaid, if their income qualifies; the New York State Bridge Plan, which requires applicants have a pre-existing condition; Healthy NY, which requires no pre-existing conditions and other limitations; and hospital charity care, a similar agreement with hospitals to help cover costs as Young had with Beth Israel during his treatments.

When the exchange opens, Chaves said she expects the role of Community Health Advocates to change drastically.

“A million people have to be enrolled,” she said. “I don't think that all those people are all going to be comfortable signing up over the phone or online. There's a lot of work to be done for disenfranchised people.”

Skeptics say, however, it will be difficult to get every American citizen coverage. People will likely try to avoid paying for coverage, said Devon Herrick, senior fellow at the National Center for Policy Analysis, a conservative, Dallas-based think tank. A penalty may not be enough to make people enroll.

“Some people could take the attitude that if I get caught, I'll pay the penalty. Even if I get caught, it's cheaper than insurance,” Herrick said. “It becomes the de facto insurance policy.”

Cost projections will probably go up, too, as doctors and hospitals continue to charge high amounts for care, he said.

“The price will absolutely be higher than estimated,” Herrick said.

And employers may also rearrange their workers' hours and wages to make it so employees rely on the exchange instead of employer plans. This will increase the number of people forced to enroll in an exchange rather than be covered by an employer.

Does the employer have at least 50 full-time employees?

Yes

No

Does employer offer coverage to employees?

Yes

No

No fine.

Does insurance pay for at least 60 percent of covered health care expenses?

Yes

No

Do any employees have to pay more than 9.5 percent of income for health insurance?

Yes

No

Employees can buy coverage in an exchange. So, the employers face a penalty of $3,000 annually for each full-time employee receiving a tax credit up to maximum of $2,000 times the number of full-time employes minus 30. Penalty goes up each year.

Did at least one employee receive a tax credit and/or use the exchange?

Yes

No

Does insurance pay for at least 60 percent of covered health care expenses?

Yes

No

Do any employees have to pay more than 9.5 percent of income for health insurance?

Yes

No

Employees can buy coverage in an exchange. So, the employers face a penalty of $3,000 annually for each full-time employee receiving a tax credit up to maximum of $2,000 times the number of full-time employes minus 30. Penalty goes up each year.

If at least one employee received a tax credit or subsidy in the exchange, the penalty is $2,000 annually times the number of full-time employees minus 30. Penalty goes up each year.

Penalty $3,000 annually for each full-time employee receiving a tax credit up to maximum of $2,000 times the number of full-time employes minus 30. Penalty goes up each year.

No fine.

Source: Kaiser Family Foundation

“Over time, there will be a restructuring of the labor market,” Herrick said. “There are many, many flaws.”

Still, the state is confident it will be able to reach a range of communities and get them coverage, Constantakes said.

And the state has a financial stake in making the program functional.

The exchange is expected to cost New York State $428 million from 2011 to 2015. The federal government will provide $2.6 billion in tax credits a year to state residents using the exchange's subsidies.

« Part 7: The Pain

Part 9: The Permanent Damage »

| All Rights Reserved