The Affordable Care Act, often called Obamacare, is one of the largest government programs begun in recent years. Along with that size, has come a lot of confusion about how it will effect medical services. As part of a series of community forums on health care, WRVO recently brought together a panel of experts to discuss how government spending affects health care in upstate New York. The experts agreed that there are many parts of the Affordable Care Act that are still a bit of a mystery, but also the impact it has on New York state will be different than other parts of the country.
“There are a lot of unknowns. We get a report almost daily about clarifications of regulations and new regulations,” said Dr. Arthur Vercillo, the president of the central New York region of insurance company Excellus Blue Cross Blue Shield. Vercillo is also a physician, and views the Affordable Care Act (ACA) through that perspective.
“I think the objective is good. The overall goal is to make sure that every American has health insurance, and in this great country, in my opinion, nobody should be declaring bankruptcy over a medical issue. And that is the number one cause of bankruptcy in this country. Everyone should have adequate coverage,” said Dr. Vercillo.
Some of the ACA has already gone into effect, and some of it has been delayed. But the part that makes sure everyone has health insurance -- the individual mandate -- starts in January 2014. Anyone who doesn't have or get health insurance by then will be fined. The good news is that New York state has relatively few uninsured people compared to other parts of the country.
“Now one thing that is fortunate about little old upstate New York, our uninsured rate in this area is one of the lowest in the country. Our uninsured rate is about seven to eight percent, which is still too high, we’d like it zero,” said Dr. Vercillo. “But there are places like Texas that are closer to 25 percent.”
And if you don't have insurance, Obamacare allows for something called exchanges, where you can go online and buy insurance if you don't have it through your employer or another government program. And according to the forum's experts, another bit of good news about New York is that the state is setting up an exchange at all -- some states have opted out.
“It’s one of the few states that moved forward very quickly to open the exchange,” said Gary Fitzgerald, president and CEO of the Iroquois Healthcare Alliance, which represents upstate hospitals. Consumers can start signing up for the exchanges in October.
“There’s going to be literally hundreds, if not thousands of people in New York state who are going to be healthcare exchange navigators, paid for by the federal government for a while, who you will be able to contact if you need help trying to understand how to shop for health insurance on the online exchange,” said Fitzgerald.
But, Fitzgerald says no one really knows how many people will sign up for health insurance through the exchange.
“There are many questions about who will take advantage, will people still refuse to get health insurance, and what will happen to those people when January 1 comes around,” said Fitzgerald. “We’re not quite sure whether or not Obamacare is going to deliver on that increased on insured population that they promised us three years ago. Hopefully, it will.”
And the key to making the Affordable Care Act work, is making sure everyone has insurance. In simple terms, the more healthy citizens who are in the pool of insured people, the more money available to pay for medical care for those who need it. And Dr. Vercillo says its unknown if that theory will actually work.
“There’s a number of parts of Obamacare that really do make sense, including, in my opinion, if we’re going to go forward with the exchanges to do so in an organized way. Now, hopefully, it will reduce some of the healthcare costs. There is some speculation that it could actually increase them,” said Dr. Vercillo.
The ACA also expands eligibility for Medicaid. And that's another area where New York is different from many states. Syracuse University professor Tom Dennison, is the director of the program in health services management and policy and an expert on public health policy.
“New York state is not going to be impacted by the provisions of the Patient Accountability Act as much as many of the other states. Our Medicaid limit is already beyond what the law calls for. Our regulation of insurance is already beyond, or approaching, what the law requires,” said Dennison. “It’s some of the states that have very low or little eligibility for states that have very poor regulation and really shoddy insurance products being marketed. They’re going to have more problems than we are.”
But Dennison warns that just getting everyone insured is not going to fix America's health care system.
“The Affordable Care Act has, or had when it was passed, significant funding for prevention. That’s being decimated Congressional session after Congressional session to pay for other things,” said Dennison. “That’s a travesty. Because we cannot fix our healthcare costs by providing more insurance, we have to do prevention. That’s a problem area.”
Dennison also says another reason healthcare costs are so high in the United States is because of -- paperwork.
“The fundamental problem about administrative costs isn’t addressed at all and that’s when I see Congress kicking the can down the road,” he said.
But it's the individual mandate that the Affordable Care Act has laid out as the next stop on the road. And Fitzgerald, like other experts, hope it doesn't turn into a roadblock.
“No one’s yet sure if this will be working the way it’s supposed to be working, and we don’t have much time, it’s coming quickly.”
You can hear more from these experts on how government funding effects health care in upstate New York on WRVO Sunday, July 14 7 p.m. when we broadcast the first in our series of community health forums. Support for the forum comes from the Health Foundation for Western and Central New York.