MIKE McCLEARY/Tribune Dr. Ted Fogarty, a radiologist at Medcenter One in Bismarck, looks for signs of a stroke while viewing multiple images of a computed tomography (CT) perfusion study of a patient's brain displayed on a computer screen. The colors in the brain scans show the blood flow in the brain. The use of the CT perfusion study is a helpful tool for physicians in the early diagnosis of a stroke. Preventative care is one of the components emphasized in the implementation of the new national healthcare system. 12-9-2010
Less than a year after it passed, the landmark changes to health care face a repeal by Republicans in the U.S. House. It took months of political maneuvering to even pass the Patient Protection and Affordable Care Act, and then in the fall health care reform helped cost some politicians their seats, including former North Dakota Rep. Earl Pomeroy.
“It pains me so much, all the heat the congressional delegation took for standing up for families like us,” said Brenda Neubauer, whose son had reached the lifetime benefits cap on one insurance plan and was nearing the benefits cap on a second insurance plan.
Her son, Jacob, 16, has hemophilia, a disorder in which his blood does not clot. She spent many years working with North Dakota’s congressional delegation to change the lifetime cap on health insurance. The new health care law finally resolved it.
The federal overhaul of health care is a politically divisive issue that will change options in the country. It will top the agenda of this congressional session and already its being challenged in court because of the mandate that all Americans purchase insurance. Although the House has enough votes by Republicans to repeal it, the effort will likely fail in the Democrat-controlled Senate.
It will be phased in over the next five years, and parts of it will be challenged in Congress. Most of the changes from the health care reform bill go into effect in 2014, although some started last September.
“When the debate started about the health care system, it was about making it more affordable to Americans, not about expanding access,” North Dakota Insurance Commissioner Adam Hamm said. “The fundamental problem is not access. The fundamental problem is affordability.”
Instead, the bill will likely raise health care costs over time, unless portions of it are changed or repealed, Hamm said. One area where the costs likely will increase is insurance premiums. For instance, Aetna is reprogramming its plans so that it reflects its adoption of the dependent coverage to age 26. Previously, plans covered dependent children until age 22 or 24 if they were students.
The cost of an insurance plan depends on what is covered. Generally, the more covered services, the greater the cost of the plan.
“Insurance premiums will have the greatest impact,” said Brenda Nagel with Aetna. “Health care costs are still rising. No one, as a nation, has addressed health care costs.”
Large employers most likely already offer some of the coverage the law now requires. It is the smaller group plans and individual plan markets that will probably see greater increases because of the need to add coverage to their plans.
For example, Aetna, which has 500 employees in North Dakota, already covers preventive care for its employees. Preventive care includes exams and tests that can help detect potential health issues before they become more costly to treat. Other businesses may not offer this coverage, which is required under the new law.
More importantly, it will change how people get health insurance, and who gets covered; as well as mandate what course of treatment health care facilities provide and to use electronic medical records to exchange patient information.
One of the biggest changes is to health insurance. More people will qualify for Medicare, and people will be required to have health insurance, or face a fine. Tax credits also will be available to some people based on income to help defray the cost of insurance. it also eliminates pre-existing condition exemptions and lifetime caps on coverage, as well as covering dependent children up to age 26.
Businesses need to offer group plans to employees or provide a voucher for employees to buy health insurance elsewhere.
For healthcare providers in North Dakota, the bill is a blessing and a curse. It included a provision that increased Medicare reimbursement rates, but it also has provisions for technology and reporting that will cost the providers additional money in equipment and personnel.
The bill included the frontier states amendment, which raises the Medicare reimbursement rate to the national average for five states, including North Dakota. The change means an extra $65 million a year in Medicare funding for North Dakota, which receives about one-third to one-half less in Medicare reimbursement than what a hospital receives in an urban area.
“Our request all along was for fair reimbursement for Medicare,” said Medcenter One CEO Craig Lambrecht.
Health care facilities will need to adhere to stricter surveillance and auditing, as well as agree to a common course of treatment for certain chronic diseases.
The hospital is anticipating more people will seek health care because they have insurance, said Dr. Anthony Tello, corporate medical director at Medcenter One.
As it is, there are some uninsured people who do not seek health care. In the long run, the uninsured are likely to require more costly medical services because they did not see a doctor before something catastrophic happens. It also is likely to reduce the number of uninsured people who go to the emergency rooms. Instead, those people are likely to go to clinics, Tello said.
Additionally, hospitals will have to report how they manage common chronic medical conditions. People then will be able to search the information through a website.
Facilities also need to implement electronic medical records. For Medcenter One, this is already used in its clinics. It will need to be implemented in the hospital, Tello said.
The law also requires providers to adhere to a common course of treatment for diseases and illnesses. Through the quality control reports, the providers will show what evidenced-based treatment they provide.
Tello worries that increased use will require them to hire more physicians, which is already difficult to do in North Dakota, especially if they are specialists, he said. That is because wages tend to be lower than in more populated parts of the country, and the location does not attract as many job candidates.
There is some fear among North Dakota health care facilities that they will not be able to comply with the mandates and consequently close, said Jerry Jurena, the president of the North Dakota Hospital Association.
“It’s not a perfect bill,” Jurena said.
For the Neubauer family, though, it eases their concerns about how Jacob will continue treatment.
“We worked many, many years and made trips to Washington because it is important,” Neubauer said. “He will have to deal with it for the rest of his life.”
For now, he has the insurance to afford it.
(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)
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