Health officials: Reform is ‘big step’

Editor’s note: This is the second in a three-part series about the effects of the Obama administration’s health-care reform on Huntington Beach and Fountain Valley health-care providers and their patients.

Dr. Peter Anderson sometimes goes for days in Fountain Valley Regional Hospital and Medical Center’s emergency room without treating an emergency. It’s not for lack of patients.

Anderson, the director of the hospital’s emergency department for 35 years, has seen increasing numbers of people check in with ailments that traditionally would be handled by a family doctor. Instead of X-raying ankles or stitching wounds, he examines chest pains and bladder infections while the suture tray goes untouched.

The reasons for that are usually twofold: Most of the people packing Anderson’s facility either can’t afford insurance or can’t get a doctor’s appointment soon enough.

The health reform signed by President Obama in March, which will expand insurance to nearly all Americans, aims to lighten the load for emergency rooms by diverting more people to the doctor’s office. But Anderson is skeptical about how that will work. He pointed to media reports about overcrowded emergency rooms in Massachusetts after the state passed a health-care reform package similar to Obama’s in 2006, and said that with only so many doctors to go around, he wouldn’t be surprised if many of the new people on the insurance rolls head straight to his doorstep.

“It’s hard to say that, with this new health-care system, there is going to be a decrease in the emergency department,” Anderson said.

A prescription for uncertainty

Anderson is not the only one in town — including even reform supporters — wondering how well the White House’s health-care fix is going to work.

Some hospital administrators in Huntington Beach and Fountain Valley have expressed gratitude for the government’s attempt to fix what they consider a badly flawed system, but also wariness about whether the reform can meet all its goals. And nearly everyone seems to agree on one point: The changes Obama signed into law will not be the last ones needed for America’s health-care system.

“It was a good first step,” said Barry Arbuckle, the president and chief executive of MemorialCare Health System, which oversees Orange Coast Memorial Medical Center in Fountain Valley. “I think, in people’s minds, it’s kind of this overarching, comprehensive thing, and it’s not. But in all fairness, we can’t expect what Obama and his team signed [in March] to be an end-all, be-all. This thing is going to be changed and altered so many times in the coming years.

“But this was a big step, no doubt about it.”

How will that big step play out in Huntington Beach and Fountain Valley? Here are local reactions to four key parts of the reform:

Putting primary care first

The government aims to boost the workforce by offering scholarships and other financial incentives to people seeking careers as primary care doctors, nurses or assistants. On June 16, Department of Health and Human Services Secretary Kathleen Sebelius announced a $250-million investment to create 500 new primary care residency slots by 2015, support the development of more than 600 new physician assistants and encourage more than 600 students to pursue full-time nursing careers.

Jon Gilwee, the senior director of government health-care programs at UC Irvine Medical Center, acknowledged that a disproportionate number of students opt for specialist careers over primary care. Of the 99 graduates who entered residency programs at UCI Medical Center this year, just 32 went into primary care fields, according to UCI spokesman Tom Vasich.

“To find someone and make it attractive to go to medical school for all the years of training, and line that up with what someone might make in a primary care setting versus what somebody is going to earn and have the potential to earn in a surgical specialty, there’s a significant disparity,” Gilwee said.

Given the large number of people who apply to the UCI School of Medicine, Gilwee said he didn’t imagine the campus would have to do any more recruiting for future primary-care workers. He noted, though, that UCI might apply for residency slots unused by other campuses if they’re available, a practice permitted by the reform.

But to Richard Afable, the president and chief executive of Hoag Memorial Hospital Presbyterian, even an influx in primary care training won’t cover all the patients that the reform will create. Like Anderson, he expects most of those new enrollees to end up filling the emergency room.

“If we started providing an appropriate proportion of primary care doctors through our medical schools tomorrow, it would take 10 years to even get close to the number of primary care doctors we need in this country,” said Afable, who oversees Hoag Health Center in Huntington Beach.

More promising to him are some of the measures the government is taking to improve the efficiency of patient care itself, such as “accountable care organizations,” in which doctors, hospitals and other providers work together to monitor a patient’s health over time; bundled federal payments to hospitals, which cover 30 days of post-hospitalization care for Medicare recipients; and the “medical home” pilot program, which funds coordinated care at community health centers.

Cheaper insurance – for more people

According to the Obama administration’s math, having more people on the health insurance rolls will lower the cost for everyone. The White House website claims that the current number of uninsured people adds more than $1,000 to the average premium of an insured family, and the bill mandates that all Americans buy health insurance if they can afford it. Opponents of the plan have argued that reforms, and greater regulations, will do just the opposite – raise rates for everyone who buys insurance.

Dee Dee Brooks, the owner of Surf City Insurance Services in Huntington Beach, expects the reform to lower the cost of insurance, because the mandate to buy will increase the number of healthy people on the rolls. Because her business opened in 1994, she said, she’s dealt with clients who were denied coverage because they were two pounds overweight or needed minor toe surgery.

Brooks, whose firm serves about 150 businesses as well as individuals, is in favor of health reform but noted that it may have a negative effect on her business and others. In 2014, when the government opens exchanges that will enable people to shop for cheap private insurance, the number of clients visiting their neighborhood insurance agent may plummet, she said.

Brooks also pointed to a rule scheduled to take effect in 2011 that requires insurance companies to spend 85% of every premium dollar on health-care services rather than overhead. If the companies have to cut costs, she said, they will probably reduce the commissions they pay to salespeople like her.

“We would take a hit if our health insurance business went away,” Brooks said. “So I tell other people [in the insurance business], ‘Get diversified. Be prepared.’”

Don Ariosto, the owner of CIF Insurance Agency in Huntington Beach, predicts that his business and others will thrive under the exchanges, because insurance companies won’t be able to handle all the requests themselves. And the reform will raise the cost of insurance, he said, because having more patients competing for doctors’ time will raise the cost of health care itself.

“I think I’m going to do fine when this thing comes out,” Ariosto said. “I just don’t think it’ll be good for our country.”

Increased services for seniors

The reform contains several measures to make care cheaper and more efficient for seniors. Starting this year, the reform will prohibit insurance companies from imposing lifetime limits on coverage and provide a $250 rebate for seniors who have hit the “doughnut hole” — a gap in Medicare coverage when seniors have consumed a certain yearly amount of prescription drugs and must pay 100% of costs until a second tier of coverage kicks in. Over the next decade, the government has pledged to close the gap.

The benefits increase in 2011 with annual wellness visits and other preventive services offered free to seniors, as well as community programs to coordinate care for them after they leave the hospital.

The changes may put an increased workload on hospitals and clinics, and not for the first time; since 2004, the number of Orange County Medicare recipients has increased by more than 60,000, according to spokesman Jack Cheevers of the U.S. Centers for Medicare and Medicaid Services.

Michelle Yerke, the head social worker for the Seniors’ Outreach Center in Huntington Beach, expects a lot of seniors to make use of that free annual checkup. Sometimes, seniors even tell her outright that they haven’t had a checkup in years.

“What I hear from our seniors is that they go in for a specific problem,” Yerke said. “The doctor addresses that one specific problem, and then they go on their way. There’s not a holistic approach in most cases.”

Still, Kuulei Fahilga, who runs the Aloha Seniors fitness group at the Michael E. Rodgers Seniors’ Center in Huntington Beach, wonders whether many seniors even know about the new services the government plans to offer them. Fahilga, a board member for the Pacific Islander Health Partnership in Orange County, sets up an information table every Tuesday at the senior center, and she said the reform rarely comes up.

The plight of the uninsured, though, is a common topic.

“Some of them will come up and say they know of someone who doesn’t have health insurance, and what can they do?” Fahilga said. “So we can kind of navigate them through different places, phone numbers they can call. I tell them, if someone doesn’t help them, to come back to us, and we’ll get them into a place where they can get their health issues taken care of.”

A break for small businesses

One of the reform’s chief goals is giving small businesses – and their employees – easier access to health insurance. Effective immediately, small businesses with fewer than 25 full-time employees and less than $50,000 in average wages may be available for a tax credit of up to 35% of premiums. The White House claims that the difficulty of obtaining health coverage discourages many people from starting businesses.

However, Susan Bock, a career consultant who lives in Huntington Beach, doubts that the reform will make much difference. In recent years, she said, the number of small businesses has grown at an unprecedented rate, and health coverage is rarely at the top of entrepreneurs’ concerns.

“The complete lack of stability with being ‘employed’ is what I hear from clients,” Bock said in an e-mail. “A large percentage of my clients are formerly employed and have seen the writing on the wall. They are choosing to start a business, or convert the skill set to being an independent contractor because they would rather be in the decision-making position about their future than allow that power and control to be in the hands of another.”

Erik Peterson, the owner of the communications company MergedNet in Huntington Beach and a City Council candidate, said he was unimpressed by the tax credit, which he said would benefit too few businesses due to its tight guidelines. Moreover, he said, most business owners he knew were wary of any kind of government assistance.

“All the small business guys, the ones with 100 employees or under, they stay as far away from any government subsidy as they can,” Peterson said. “They just do. If you’re getting something from them [the government], they want you to act a certain way or do a certain thing. Nothing’s free.”

Still, fellow council candidate Dan Kalmick, who owns Flashlight Technologies in Seal Beach, said the reform would benefit at least a few.

“I would guess that it would lower one of the barriers to starting a business,” he said. “There are many barriers to entry, of course. But logic would say that if it’s cheaper to get health insurance or easier to get health insurance, then it would definitely be easier.”

Timeline of health-care reform

Here are some of the changes the Obama administration has proposed for the next five years:

2010: Insurance companies can no longer deny coverage to children with preexisting conditions, drop people with coverage when they get sick or impose lifetime limits on insurance coverage.

Small businesses are eligible for a tax credit of up to 35% to provide health insurance to employees.

All new health plans must offer certain preventive services such as mammograms and colonoscopies for free.

States receive increased federal funds for Medicaid.

2011: Seniors receive annual wellness visits and other preventive services for free.

New federal funds support construction and expanded services at community health centers.

The law requires that at least 85% of all premium dollars collected by insurance companies for large employer plans, and at least 80% for individuals and small employer plans, are spent on healthcare rather than paperwork and overhead.

2012: Physicians receive incentives to form “Accountable Care Organizations,” which aim to coordinate patient care and reduce unnecessary hospital admissions.

Hospitals begin phasing out paper records and implementing electronic systems.

2013: Primary care doctors receive increased Medicaid payments.

Under a pilot program, hospitals, doctors and providers are paid a collective flat rate, or “bundled payment,” for a single episode of care rather than multiple payments to different providers.

2014: Insurance companies can no longer deny coverage to adults with preexisting conditions or impose annual limits on coverage.

Health insurance exchanges open in each state to allow individuals and companies to shop for more affordable insurance.

Individuals and families who earn less than 133% of the poverty level are eligible for Medicaid.

Source: https://www.whitehouse.gov.