Health care reform questions still loom in state, despite court's ruling

jprice@newsobserver.comJune 28, 2012 

The vigil for a decision from the Supreme Court on “Obamacare” is over, but across the Triangle uncertainty over the future of health care isn’t.

“This settles the case legally but not politically,” said Jonathan Oberlander, a professor of Social Medicine and Health Policy and Management at the UNC-Chapel Hill, who studies and teaches about health-care reform.

Patients, health-care providers, hospital administrators, small-business owners and insurance company executives alike are still mulling not only the meaning of the complex decision, but also how the white-hot politics surrounding it could still affect the law.

Senior administrators at the region’s three major hospital systems, Duke, UNC and WakeMed, said that the court decision hardly ends the nation’s long struggle with health-care reform, though it’s good to have even a little better sense of how reform might move forward.

“This provides some clarity to all parties that are involved in financing and delivering health care – hospitals, doctors, insurance companies, employers,” Brian Goldstein, vice president and chief operating officer at UNC Hospitals said in an emailed statement. “While there will still be some uncertainty ... I hope that we will all be able to start working together more intensively to design contracts that emphasize improvements in quality and safety.”

Hospital administrators said their organizations had already begun changes spurred in part by the law, including adding substantially more primary-care physicians and focusing more on primary-care and preventative medicine.

Victor Dzau, president and CEO of Duke University Health System, said that getting health coverage for as many as possible of the state’s 1.6 million uninsured will improve their health care by changing the way many of them get it. Often enough, they wait until a problem becomes serious, then go to a hospital emergency room.

But Dzau thinks all the changes in the works would have a negative effect on hospital finances. More patients will have coverage, but there also will be large cuts in reimbursement. The federal subsidy for treating uninsured patients also would end.

The law isn’t perfect, and there are significant challenges and more reform will be necessary, Dzau said. But expanding coverage is a good thing, he said, and Duke shares the law’s broad goals – higher quality care, lower costs and more access. “I think for us, it’s accelerating the pace of things that we believe are the right things to do,” he said.

Area hospitals absorb millions a year in costs of treating uninsured patients, but Bill Atkinson, CEO of WakeMed, said consumers shouldn’t be fooled by that: someone pays.

Call it whatever you want, Atkinson said, the United States has long had government health care. People just don’t realize they’re paying for it.

“The current system is broken,” Atkinson said. “It’s not sustainable for anyone and certainly not the taxpayers, and we’re going to have to find a better way to do this.”

Oberlander said that it seems likely that the decision by the high court to let the law stand will be a good thing for the hospitals’ bottom line.

The nation’s growing deficit makes it likely the federal government would eventually have to cut reimbursement anyway, he said. With the law, at least, hospitals will be assured of more customers with coverage.

Still, the uncertainties that remain worry people like Tiffany Harvell, 25, and her fiancé, Joseph Zandlos, 37, of Raleigh.

She does odd jobs and is a stay-at-home mom, and he’s on unemployment. They still make too much to qualify for Medicaid, the government health insurance program for the poor, but they would under an expansion dictated by the reform law.

First, though, they must wait to see if politicians who oppose the law can get the numbers they need in the fall elections to quash it, or whether the state government agrees to the expansion.

“That very first day it becomes available, we will definitely sign up,” Harvell said.

They are lucky, she said, to get basic care from the Alliance Medical Ministry – a non-profit that serves more than 8,000 uninsured patients in Wake County – for $15 a visit. But they don’t have coverage for eye or dental care or major problems, such as an accident that badly broke Zandlos’ leg last fall. Medicaid covered the initial surgeries but not follow-up visits and continuing rehabilitation, so the couple pays about $400 a month toward his rehab and a backlog of medical bills.

On the whole, the health-care law is a good thing for patients of modest means, said Brian Toomey, CEO of Carrboro-based Piedmont Health Services, which runs seven clinics that offer primary care, dental and pharmacy to about 40,000 patients from 14 counties.

More than half of Piedmont’s patients are uninsured, he said, and most pay $25 a visit, with a sliding fee scale that allows some to pay less or receive a payment plan. Demand is so high that three of Piedmont’s clinics must turn away hundreds of patients each month. Some find care elsewhere, but others, Toomey said, “just hope illness goes away.”

Having more patients covered, he said, could allow Piedmont to build more clinics to ease that problem. “It’s a terrible thing to have to say to a patient who we know needs help that we can’t see them,” he said.

Oberlander, the UNC professor, said one thing about the law is certain in North Carolina: Its status as a battleground state means a months-long bombardment of “Obamacare” political ads is inevitable. “If you think you’re sick of hearing about health-care reform now, just wait,” he said. “There’s more coming.”

Regardless of what happens with the election, and to the law, there will have to be more health-care reform, Oberlander said. “Health care reform is an ongoing process in this country,” Oberlander said. “We’re not even close to being there.”

Price: 919-829-4526

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