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.