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GUEST COLUMN: Health care reform ultimately helps Missourians

Thursday, July 29, 2010 | 5:00 p.m. CDT; updated 1:52 p.m. CDT, Monday, August 2, 2010

It's a truism: A rising tide lifts all boats.

The same idea holds true for health care reform; if we participate, all Missourians can benefit. Across the country, most of the 45 million people who are uninsured are from working families. In our state, that's 543,300 people, or enough people to fill the seats in Memorial Stadium almost 8 times. Although some may choose to be uninsured, the overwhelming majority does not. High insurance premiums, the lack of insurance availability for part-time, small business and service employees, and the loss of a job keep too many of Missouri's hardworking families uninsured.

For years, I have seen health care costs rise with little improvement in my patients' overall health status, and I am not alone. Even insured patients struggle to pay for needed medicines and put off treatment for diseases because they cannot afford the high co-pays and deductibles. It is not just individuals. Businesses large and small are continually being priced out of insurance coverage for their employees. Even public insurance programs, such as Medicaid and Medicare, are on the edge of bankruptcy.

It no longer has to be this way. Access to affordable quality care for all Missourians could soon be possible. Many people from all walks of life supported health care reform because everyone can benefit. Hospitals and physicians' organizations, including the American Hospital Association, the American Medical Association, the American College of Physicians and the American Academy of Pediatrics, all joined to support health reform. Health insurers, the pharmaceutical industry, the AARP and many private businesses took up the charge as well, making the passage of the Affordable Care Act an important step in changing our health care system.

While change this big and complex can be daunting, the results can be dazzling. The benefits of health care reform include:

• Letting children stay on their parents' insurance up to age 26

• Covering more low-income people who are uninsured

• Providing tax credits for small businesses that offer coverage to employees

• Providing financial help for low- and middle-income people to purchase health insurance

• Requiring insurance companies to present information in ways the average person can understand

• Requiring insurance companies to stop looking for reasons to drop you once you become sick

• Requiring insurance companies to stop denying coverage for patients with existing health conditions

• Creating new insurance "exchanges" to make real cost control and regulation a reality

Along with these changes, almost everyone will have access to affordable health coverage and will be required to maintain health coverage by 2014.

This last part, what is also called an "individual mandate," remains controversial. Experts think that this mandate is needed in order for the entire set of health reforms to work, but understandably, many people are worried about government intrusion into their lives.

Missouri will be the first state in the nation to address the issue with a statewide vote on Aug. 3 through Proposition C, The Health Care Freedom Act. Opponents of the individual mandate call it a violation of individual freedom. However, health care mandates are not new. President Nixon proposed such a system in the early 1970s, and the idea has surfaced repeatedly on both sides of the aisle in Congress.

The individual mandate requirement in the new law does not take away an individual's freedom to choose. Individuals may review their health insurance options and choose where to get their health coverage. This may be through or outside their employer. In fact, many policy experts agree that Missourians in the individual and small group markets will ultimately opt to purchase insurance through the proposed state exchange, not because they will be forced out of their existing plans, but because they are savvy health consumers. New plans will offer enhanced consumer protections, and the larger insurance pools will result in better choices, or more stable and affordable insurance products.

Individuals can even opt out, choosing no insurance. Those choosing to opt out, however, will be subject to a fine, with exceptions made for religious beliefs and economic hardship. The idea is that having nearly everyone participate makes premiums more affordable for everyone. It also helps us to avoid other taxpayer-borne costs that currently exist, such as public subsidies for providing free coverage to uninsured individuals.

One key point to consider is that the individual mandate to have health insurance reduces everyone's average premium to a manageable cost. This approach is expected to save money for Missouri and our nation. Residents of Massachusetts, the only state that already has an individual health coverage mandate for individuals, saved 40 percent in annual premiums from 2006 to mid-2009. During that same period, the rest of the nation bore a 14-percent increase in premiums.

On Aug. 3, Missourians will be asked to vote on whether they agree with the individual mandate. I encourage everyone to learn more about this complex issue. There are strong arguments on both sides, but as a doctor, I am constantly reminded that Missouri's health indicators (rates of smoking, obesity, diabetes, etc.) are bad and getting worse. I don't know how it will all play out, but I am willing to give this a chance. It is clear that we need to chart a new course, one that will raise the tide and help all Missourians.

Karen Edison is a medical doctor and director of the MU Center for Health Policy, a group that has been working for practical solutions for health care reform since 2003.


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Comments

Neal Winslow July 29, 2010 | 5:59 p.m.

I will have to disagree with this article. I am a healthy single man, 41 years old. Just this month I received a notice from my health insurer that my premium was going up by 36%. I'm extremely displeased with it - but what can I do?

(Report Comment)
Ray Shapiro July 29, 2010 | 8:53 p.m.

("I am constantly reminded that Missouri's health indicators (rates of smoking, obesity, diabetes, etc.) are bad and getting worse.")

These are diseases of lifestyle choices and people have the right to do to whatever they want to their bodies if it's a legal coping mechanism or if it's a result of the few legal pleasures left which they choose to indulge in.

Be a doctor, not a mommy to your patients.

And if ObamaCare is so great, why do you have to be such a Mary Sunshine about it? Why tout it as the new cure all? Is it because you are trying to cover up the storm that's brewing as a result of it being pushed upon those who want to and/or are able to live free and independent of federal government intervention or because you seek dependency to validate your life and career choice?

ObamaCare rocks some boats big time. And it's going to capsize and overturn some of them.
People will drown in the bureaucracy.
And then you can call yourself a Federal Employee, physician.

(Report Comment)
John Schultz July 30, 2010 | 1:57 a.m.

Neal, try looking at the private market. I recently made a job switch, was not happy with the indemnity plan offered by my new employer, and purchased a plan for myself on the private market for approximately $150/month. It's a high-deductible plan, but I could have purchased a lower-deductible plan for a higher monthly premium.

I find the claims in this article somewhat twisted. "The individual mandate requirement in the new law does not take away an individual's freedom to choose." and then a paragraph later being told "Individuals can even opt out, choosing no insurance. Those choosing to opt out, however, will be subject to a fine, with exceptions made for religious beliefs and economic hardship."

I think it would also have been good to see a citation of the claim that "Residents of Massachusetts, the only state that already has an individual health coverage mandate for individuals, saved 40 percent in annual premiums from 2006 to mid-2009. During that same period, the rest of the nation bore a 14-percent increase in premiums." That is an astounding number if correct, but I have serious doubts on those numbers. I'm going to assume the linked document below is what Karen Edision was referring to:

http://voices.washingtonpost.com/ezra-kl...

If so, the link below has some rebuttals:

http://www.cato-at-liberty.org/2010/06/2...

"The individual market accounts for just 4 percent of the private market, and premiums in that market were higher than for employment-based coverage. When the two markets merged, the price controls that Massachusetts imposes on health insurance led to an averaging of premiums: premiums for individual purchasers fell, and premiums for small-business employees increased to pick up the slack. That is, RomneyCare shifted costs from people who purchase their own coverage to workers who obtain coverage on the job."

and

"We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent in aggregate, and by about 7 percent for firms with fewer than 50 employees. The effect of reform on family premiums is less uniform. If Massachusetts is compared to the nation as a whole, reform had a modest 1.5 percent effect on family premiums. However, in the Boston MSA, and among employees of small firms, the effect of reform on family premiums was much greater. Family premiums grew by about 8 percent more in Boston than in the 19 largest other MSAs from 2006-08, as compared to 2004-06. For small employers, the differential Massachusetts/US growth in small-group premiums from 2006-08, over and above the growth from 2004-06, was 14.4 percent."

The full study can be read at http://www.bepress.com/cgi/viewcontent.c...

(Report Comment)
michael webster August 1, 2010 | 10:35 a.m.

Nice article. I would like to add another observation.

There is way to access the health tax credit to get affordable health benefits.

You need to combine a limited medical benefits program with a high deductible HMO. The limited medical benefits program by itself is not eligible for the tax credit, but when bundled with an HMO, the whole package may be eligible.

I go through the example here: http://www.franchise-info.ca/supply_chai...

(Report Comment)

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