Athens community confused about healthcare reform

 by Chari Sutherland

Sean Bokelman, a local restaurant manager, doesn’t have health insurance.  The last time he had insurance was three years ago when he was still covered under his parents’ plan.  Patricia Porterfield, a hairdresser in the Athens area, buys a personal plan. 

“I’m self employed and it’s the only way I can get insurance,” she said.  “Either I pay or I have no insurance.” 

With the recent passing of the healthcare bill, many questions still linger for those in positions like Bokelman and Porterfield.  The most pressing questions are: will insurance costs be lower?  Will self-employed persons be positively affected by this reform? With the national mandate that every American must have insurance, who will monitor this? 

White House.gov has devoted several pages on their website to answering the public’s questions about this reform.  The site states that insurance premiums will not go up, nor will co-pays or deductibles.  Also, those who are self-employed will have access to cheaper insurance through insurance exchanges. 

An opinion poll by CNN/Opinion Research Corporation conducted in December, 2009 found that 39 percent felt the health reform bill would not make any real changes at all, 37 percent felt there would be changes for the worse and 22 percent felt there would be change for the better.  An ABC News/Washington Post Poll conducted in November, 2009 found that 55 percent of persons polled considered themselves to have a “good basic understanding” of the changes being proposed for the health care system.  Another 44 percent felt the changes proposed were too complicated to understand.  However, a Gallup poll in that same month found that 36 percent of those polled felt changes in the healthcare system would make their personal healthcare situation worse.  Only 26 percent felt it would improve. 

On top of this, many in the insurance industry remain in the dark about what the reform will really mean for the self-employed or anyone else for that matter. 

“I feel just about as clueless as everyone else,” said Dustin Rector, an insurance agent at Baumwald Insurance.  “The bill is very vague.  Seems like (its) impact will be very delayed.”  Some of the proposals in the bill will not take effect until 2014.   

Debbie Kinard, of Blue Cross Blue Shield was unsure of the effectiveness of the healthcare reform.  She said no one is addressing the basic problem: increasing costs.  “We have to stop the runaway freight train of costs going up.”   She said there is a common misconception that health insurance companies get rich from premiums they offer.  In fact, she said, health insurance companies only make about three percent profit.  Pharmaceutical companies make ten to 15 percent. 

There’s a domino effect driving costs, she said.  For example, if the cost of needles increase, then bed sheets increase, then doctors’ leases increase, and thus hospital costs increase.  “The general public doesn’t understand that.” 

Windy Manders, an insurance agent with Chastain and Associates, said her company is selling more individual policies due to consumers losing coverage at work or losing jobs.  She pointed out that the cost of doctors and hospitals serving the uninsured drives up medical costs.  “The hospitals and doctors are going to make up cost of seeing the uninsured somewhere.” 

Dustin Rector of  Baumwald Insurance agreed.  “It’s not uncommon for a premium to go up at least ten percent every year.”  His company has sold less individual policies this year because of the shear cost of them.

Manders said people have to remember insurance companies are a business, too.  “If they’re paying out more money than you’re paying in, they can’t make a profit.”  If they can’t stay in business, they can’t provide insurance to the public.

 One proposal of the reform bill is the use of insurance exchanges for the self-employed to find good rates on insurance by being grouped with other self-employed persons buying insurance.  Neither Manders, Rector or Kinard could elaborate on how the exchange system might work.  Rector offered an explanation of why they could be beneficial.  The theory, he said, is if the healthy are combined in a group with the unhealthy, it will bring down the premiums of the unhealthy and everyone’s cost will meet in the middle.  “If the healthy are paying $100 a month on insurance and the unhealthy are paying $600 a month, when you group them all together, they might all pay $300.”  He said this lessens the risk for the insurance companies.   

“I don’t see the healthcare bill lowering costs for us,” said Brandt Halbach, Executive Director of Georgia Neurological Surgery, a practice located on Old W. Broad Street in downtown Athens.  This practice’s patients include 30 percent on Medicaid or Medicare.  Another nine percent are self paying or privately insured.

Halbach said the economy of healthcare is different than any other business.  When you go to a store and buy a basket of goods, the store gets their payment on the spot.  It’s not that way in healthcare, he said.  After the provider collects the co-payment from the patient, the bulk of the expenses are sought from the insurance company.  It can take up to 60 to 100 days to get payment.  If the insurance company denies payment, doctors often appeal.  “We need personnel to follow up on these things,” he said.  “Those costs are in the system.”

As far as the mandate that all Americans must have insurance or be fined, that concerns many. 

Manders questioned, “If a person without insurance couldn’t afford it to begin with, how are they going to afford it after a mandate?” 

Kinard and Bokelman were concerned about citizen rights. 

“If you take over health insurance and it is now run by the government, that’s the beginning of losing freedom of choice and self regulation,” Kinard said.  She also wondered how a mandate will be enforced.  However it is enforced will likely result in loss of some privacy she said.  “Are we going to have a national database so the ‘health police’ can come out and knock on your door?”

Bokelman said the idea of levying fines on those who remain uninsured “seems like a violation of my rights.  I get the point—if everyone’s covered it will be cheaper for everyone.  But to make it mandated…it blows my mind.  Especially considering the foundation of this country.”

In any case, Rector said his understanding of the new reform is that the changes will come about in several years.  “I really don’t know what’s wrong or what’s right with the bill,” he said.  “But what we have now isn’t working well either.”

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