| 03.17.2018

The good, the bad, the ailing — Local experts weigh in on ‘Obamacare’ as enrollment continues


Eight-year-old Anthony Skore is the only one in his family with health insurance.879205_33166407His dad, Derek Skore, was one of many victims of a still-recovering economy in 2010, when, after enduring several rounds of layoffs within his Seattle construction company, his luck finally ran out.

Since then, he’s found employment at a local Home Depot — where his skills are useful and appreciated — but the company keeps him teetering on the edge of part-time employment, just below the requirement to receive benefits.

Derek and his wife, Kelly, have lived without coverage for more than two years. That, however, is about to change.

The Skores are among the 332,000 Americans who have enrolled in private health insurance plans under the Affordable Care Act, or Obamacare — as it’s more commonly known.

“It gave me such a feeling of relief,” said Kelly Skore, a Washington State University alumna. “Finally, we could get out from under that burden — that fear — that we couldn’t go to the doctor when it was something we wanted to do, as opposed to something that was absolutely life threatening … because we won’t go to the doctor — especially my husband.”

For the Skores and thousands of families like them, the ACA seems to be accomplishing exactly what it was intended to. That is, lend a helping hand to those who might not be able to afford coverage on their own. Despite this, the policy is surrounded by controversy, and remains an issue on the forefront of a political fray.

The “Obama” in Obamacare

The policy has been widely regarded as a fiasco for the Obama administration by mainstream media. According to an internal memo produced by the White House on Sept. 5, the Obama administration estimated that roughly 500,000 people would have enrolled in health coverage within the first month of open enrollment. The actual figure was just over 106,000.

The low numbers may not be solely a result of an aversion to the policy. On Oct. 1, the first day of open enrollment, bottleneck traffic and other software glitches on the Healthcare Marketplace website made it impossible for many to enroll. The White House re-launched a more functional version of the website on Dec. 1, but not before hundreds of thousands of confused and frustrated consumers had been alienated by the program.

The ACA is no stranger to adversity, though. The policy was reviewed by the Supreme Court following the challenge to its constitutionality by 25 states, including Idaho.

The Court upheld the individual mandate, which essentially requires everyone to have health coverage, but ruled that the policy offered too little notice and too great a penalty to states that did not accept the Medicaid expansion. This aspect of the policy became left up to the states — either they could accept the expansion, which would make millions more American eligible for Medicaid, or pass without penalty.

Washington is one of 25 states that chose to accept it, and it is because of this that the Skores now qualify for Medicaid.

In Idaho, however, it’s a different story.

Unlike its more liberal cohort, Idaho has not accepted the Medicaid expansion. According to University of Idaho political science professor Don Crowley, this means approximately 233,900 Idahoans — many like the Skore family — will largely be left with their current health care options.

“Ten percent (of Idahoans) could get Medicaid but won’t because the legislature hasn’t expanded, and in at least the first couple of years the Affordable Care Act expansion is free — the federal government pays for all of it,” Crowley said. “Basically, Idaho is refusing to grant people above but near the poverty line the ability to get medical insurance through Medicaid and to get it free, and our federal taxes aren’t going to go down because we refuse to expand. Basically, Idaho is subsidizing the states that did take the expansion.”

Despite the hype about health care reform, most Americans won’t see that much change, according to Crowley. UI law professor Richard Seamon said the ACA is a small step rather than a leap in any direction.

“It’s the beginning of an important process,” Seamon said. “It’s comparable to prior major legislation like Medicaid and the Social Security Act that have been amended numerous times, but no one today questions their usefulness. Still, it’s going to take five to ten years before all the bugs are worked out, and (the policy is) accepted as part of the landscape.”

Crowley and Seamon agreed that people will find many of the things they were led to believe about the ACA were nothing more than sensationalized misconceptions. Many aspects of the policy, such as death panels and doubling premiums, simply aren’t true. The most significant fallacy, Seamon said, is how much Americans are going to have to pay for insurance.

“(Many believe that) all of a sudden, insurance is going to be a lot more expensive than it used to be, but for most people, the opposite is true,” Seamon said. “A lot of people are going to be eligible for government subsidies that help make health care more affordable — that’s why it’s called the Affordable Care Act.”

Crowley said he estimates 3 to 5 percent of Americans will end up paying more for their coverage.

“These people aren’t terribly happy,” Crowley said. “But the number of people who will benefit will vastly outnumber the people who are hurt, and most of the people who say negative things about it won’t really be affected at all.”

The “care” in Obamacare

At Moscow Family Medicine, physicians see both sides of the issue, both as health care providers and consumers. While there continues to be debate on the consumer side of things, there’s little question among providers as to whether reform is necessary.

“There isn’t anybody that believes we can continue to afford what we’re doing today,” said Jeff Geier, certified medical practice executive and administrator of MFM. “What all this means is that the health care system in the United States has to continue to evolve. I don’t think anybody has a good enough crystal ball to see exactly what it means or what needs to happen. We need to keep talking about it, and tweaking things to get better, lower cost, higher quality system. It won’t be like throwing a light switch — it’ll be like turning a dial to improve the system.”

For Gritman Medical Center Chairman BJ Swanson, the need for change was all in the numbers. The U.S. used to be rated No. 1 in the world for health care by the World Health Organization. This year, the U.S. fell to No. 37. The U.S. also claims the title of most expensive healthcare in the world, spending nearly double what Norway, the closest runner up, does.

“Our health care system was broken,” Swanson said. “Something had to change. The Affordable Care Act isn’t perfect, but it gives us the opportunity to mold how things happen in the future … with something like this that is such radical change, we just have to look forward to how Gritman, and how the community, are going to fit into this and how we can create opportunity, as well as communicate very seriously about the wellness of the community.”

Administrators at Gritman have been studying the policy since its implementation in 2010, and according to Swanson, it has been necessary for the hospital to change many of their business and administration practices to accommodate the policy. More than anything, though, the hospital intends to take the chance to use the policy as a springboard to reevaluate how they serve the Palouse.

While they agree the ACA is a step in the right direction, Swanson and Geier also believe it’s not a permanent solution to the nation’s health care problems.

According to Geier, the priority needs to be moving out of an episodic payment system — which pays physicians based on the number of times they see a patient — to a more value-based model — where physicians are reimbursed based on quality of care rather than how many times it’s delivered.

“The goal of providing every American with insurance is a good and noble one,” Geier said. “But if that’s all the reform accomplishes, it will do nothing but drive up the cost of health care, but what we’re trying to control is lowering the cost of health care per person in the country, so there have to be other reforms other than providing insurance for people who don’t have it.”

Perhaps that’s what lies ahead in the U.S. discussion on health care.

The policy permits children to stay on their parents’ plans until they’re 26. For those who aren’t covered under their parents’ plans, the Student Health Insurance Plan is considered a “gold” plan by ACA standards, according to Assistant Vice Provost for Student Affairs Greg Tatham.

For these reasons, many University of Idaho students won’t have to spend too much time worrying about health insurance — for the time being, at least.

And — for all its shortcomings, controversies and turbulence — with the implementation of the ACA, the Skores and thousands of families like them won’t have to worry, either.

“I hope good things will come out of this,” Kelly Skore said. “I haven’t used the coverage yet — I have a lot of questions about how it’s going to go — but I’m certainly very relieved just to have it.”

Hannah Shirley can be reached at arg-news@uidaho.edu

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