How S.C. doctors, others feel on health care bill

Mar 29, 2010 — The State

Joey Holleman, Andrew Shain and John O'Connor

Mar. 27, 2010 (McClatchy-Tribune Regional News delivered by Newstex) -- One is opposed but resigned.

The other thinks it is great.

Both are Columbia doctors.

Welcome to South Carolina's reaction to health care law passed earlier this week.

Angry. Ecstatic. Unsure.

When a proposal affects one-sixth of the U.S. economy, disagreements and confusion can be expected.

The American public doesn't seem to know what it thinks about the law. Polls consistently found a majority disapproved of the proposal. Then, when it became law, a USA Today/Gallup poll said a plurality approved.

But while opinions are strong, there also is a great deal of wait-and-see confusion, even among Midlands doctors, hospitals and insurers.

Dr. John G. Black, president of the S.C. Medical Association, fired off a letter to the editor of The State soon after the health care bill passed on Sunday. It was a slightly altered version of his letter to members of the Medical Association, pledging not to be content with flawed legislation.

Three days later, Black's stance had mellowed a bit.

"We have to adapt to it," Black said Wednesday of the new law. "(Physicians) had very little voice in what the final outcome has been, but it's been passed into law.

"The good thing is we do have a good bit of time before most of the provisions kick in. The public needs to be aware that nothing big is going to happen soon."

Black says the legislation will make health care more accessible and affordable to millions, but he worries the legislation does little to address cost issues.

For example, physicians had pressed for a repeal of a Medicare policy that annually allows Congress to reduce payments to doctors. In reality, Congress seldom reduces those rates. But the threat is there, every year, to the business side of medicine. This year, the proposed, but unlikely, cut would be 21 percent.

"In the last 20 years, medicine has become more of a business," Black said. "Government programs have promised too much, and they discount (physician) payments to cover for it."

Another threat? With the rise in the cost of medical school -- new doctors reported $22,000 in school loans in 1984 vs. $122,000 in 2007 at public schools -- new physicians may be lured away from lower-paying primary care to higher-paying specialty fields, just when millions of new patients will need primary-care physicians.

"The emergency rooms are already crowded with people who don't have family doctors," Black said. "The challenge is there's a shortage of primary-care physicians."

If Black is unhappy with the new law, Dr. Saundra Glover sees it as a godsend.

As director of the Institute for Partnerships to Eliminate Health Disparities at USC's Arnold School of Public Health, Glover works to close gaps in the health of South Carolinians.

According to state health statistics, S.C. minorities are three times more likely than whites to die of prostate cancer or diabetes, 2.6 times more likely to die as infants, two times more likely to die of stroke and 1.5 times more likely to die of all cancers or heart disease. They also are five times more likely to have HIV.

"I certainly see (the new law) having a huge impact in terms of reducing health disparities in a number of ways," said Glover. "By providing coverage for 35 million people who don't have insurance or are underinsured, it really addresses the minority population."

More screening and prevention programs, and better access to health care should make a difference, Glover says. Also, the new law's expansion of the community health center system should make it easier to set up centers in poor communities and make primary health care available to more people, Glover said.

Changes in health insurance should cut down on unjustified rate increases and denials of coverage for pre-existing conditions, both of which "have been barriers for health care for minority populations," Glover said.

"I know the process enough to know that everything I wanted to see in the legislation would not get passed this round," Glover said. "But (the new law) gets at a lot of issues that are critical for low-income and middle-income families and small employers.

"I'm a happy camper."

While more people will get health insurance, those who already have it -- or could afford to get it -- might pay more, South Carolina's largest insurer says.

Insurers must cut the gap between what they charge those most likely to get sick and those least likely to need a doctor, said Jim Deyling, a senior vice president at BlueCross BlueShield of South Carolina, with more than 6,800 workers the second-largest private employer in the Midlands.

Many people who now take a pass on health insurance are younger and healthier -- and less costly to insurers.

"For younger, healthier people, their premiums will go up substantially," Deyling said. "And if you're not buying a policy at $150 (a month), are you going to buy one at $250?"

Deyling said he would like to see a more costly penalty than the one proposed for those choosing not to get insurance. "We need more of those (younger, healthier) people if we're going to take on more sicker people," he said.

Premiums for those younger, healthier customers could rise 40 to 60 percent once the new health care laws' rules go into full effect in 2014, Deyling said.

The good news for people with greater health risks is their premiums won't increase as much as they have in recent years. They even could drop if those customers are eligible for government subsidies, based on age and income, Deyling said.

The requirement for insurers to take patients with pre-existing conditions by 2014 should not affect BlueCross as much, he said.

The rule change applies to people who buy policies for themselves. Pre-existing conditions are covered for those getting policies through work. Individual policies only make up 6 percent of the 1 million-plus people that BlueCross insures directly or indirectly, Deyling said.

"We will figure how to make this work," he said.

More people are expected to come to hospitals run by Palmetto Health as health care reform provisions take effect.

But does that mean Columbia's largest private employer -- with more than 7,400 workers -will add jobs?

Chief executive Chuck Beaman said Thursday that he's unsure. But, he added, Palmetto has been adding workers as hospital visits have risen due to the aging population.

Patient growth already was projected to increase by 2 percent to 4 percent a year. And that was before health care reform, which will provide more people with access to insurance, Beaman said.

A big change: Palmetto expects to lose less because patients are unable to pay their bills. Last year, Palmetto's patients did not pay $350 million in bills, up from $208 million in 2006, as the economy worsened.

"They will now have insurance," Beaman said.

While getting something is better than getting nothing, Palmetto also must prepare for lower reimbursement rates from the federal government for Medicare and Medicaid patients.

Now, S.C. hospitals are paid about 85 cents for every $1 of their costs for government-supported health care programs, he said.

In the end, Beaman said he thinks health care reform should mean smaller increases in hospital costs -- and smaller hikes in patient bills.

Mark Tompkins wrote a graduate paper on health care when he came to USC in 1976.

His paper "dealt with the growing cost of health care and the fragmented delivery of care and that there wasn't enough work being done to improve the quality of care," said Tompkins, now a USC professor of political science with a focus on health care.

"By golly, it sure has taken a long time."

Tompkins traces the debate over government's role in health care to President Teddy Roosevelt, whose 1912 Progressive Party platform had a public health care plank. Major upwellings on the subject surfaced under Presidents Franklin D. Roosevelt, Harry Truman, Lyndon Johnson and -- behind the scenes -- in Richard Nixon's White House. Then, the Clinton administration tried again, but its health care initiative failed to gain traction.

"It's funny, but the current law looks an awful lot like the market-based proposals the Republicans made to counter Clinton in 1993," Tompkins said.

The difference is health care costs now are through the roof and so are the consequences of failing to act, he said. That's one reason the new law won nuanced support from hospitals, drug companies and insurance companies.

"The bill's a mess, of course," Tompkins said.

"But, in many respects, it's a constructive step forward."

USC junior Laila Hussein said she has mixed feelings about the health care law.

Hussein, 20, is a type 1 diabetic who relies on a half-dozen prescriptions to stay healthy. She has coverage under her parents plan, but was worried where she might find insurance if she decides to attend graduate school. Most insurers, she has learned, will not cover her on her own.

The new health care law allows parents to cover their children until age 26, adding a safety net for Hussein and others as they decide when to start their careers.

"I'm someone who wants to be self-sufficient once I graduate," Hussein said. "Should I need something to fall back on there's something."

Hussein, an Irmo native, is studying biology and English, and had considered becoming a doctor if only to make it more likely she would have access to medical care. Hussein said both she and her parents have been "freaking out" about the prospect of her losing insurance coverage.

But though Hussein stands to benefit from the new law, she also knows it will come with a cost to others. It will take time, she said, before the country learns the full impact of the law and if there are any unintended consequences.

"I don't think it's as clean-cut as it's being presented," Hussein said. "It's not a good thing. It's not a bad thing. It's something that's going to require sacrifice on both side."

As the human resources manager for more than 200 employees at Talley Metals Technology Inc. near McBee, Jerry Kershner is just getting his arms around how the law will impact his employer.

Extending coverage for dependents until age 26, requiring full coverage of preventative care and stripping annual limits on coverage, Kershner said, are going to cost money.

"It's way too early for us to have crunched the numbers," Kershner said. "I do feel it will have an impact on us negatively long-term...those costs are going to be passed on in premiums at some point."

Kershner said employees will notice other changes too, such as halving maximum flexible spending accounts to $2,500 from $5,000 a year. Many employees, he said, use the accounts to pay for braces and other medical expenses.

Talley Metals, Kershner said, might have to add employees to manage the paperwork required by the new law.

Kershner said he personally opposed the bill, and worries about the Internal Revenue Service tracking the cost of health care benefits. Adding that information to tax documents, he said, might be the first step toward taxing the benefits.

He said it's possible some businesses might decide to eliminate coverage, choosing a $2,000 penalty per employee over insurance costs that can total several thousand dollars more per employee than the penalty.

That would force people to the soon-to-be created health insurance exchanges, Kershner said, where they will face complicated and confusing options.

"If you think they don't understand (retirement) stuff," Kershner said, "try negotiating health care."

Newstex ID: KRTB-0044-43340422