Here we are in the second battle of the health insurance war, where the enemies of reform reignite fears that the new federal law will close hospitals and small businesses, drive doctors from practice, ratchet up everyone's insurance premiums and generally reduce the country to ruin.
This phase should end the day after the general election and a new one will begin, when every economic mishap will be blamed on the health-reform law.
The talking points in business forums, insurance company fliers, Republican speeches and news analyses generated by the critics mostly follow the themes of the campaign against the law last year, but now the opponents must deal with the phases of the law that are being implemented now, which are uniformly popular. So the strategy is to generate fears over things that the law might do years in the future.
They adopt the debater's strategy and attack the law's strongest points. Thus they continue to try to scare us old folks by suggesting that it will one day take away Medicare benefits or make us pay much more for hospital and physician care. The truth is Medicare coverage is strengthened and the program's solvency is assured another 10 years. The gap in drug coverage will be closed, drugs will be cheaper and people for the first time will get preventive care like cancer screenings at no cost.
A seminar on the new law for Arkansas employers illustrated the strategy. The new law, the participants said, was going to raise the premiums of everyone who is already insured and drive to the wall businesses that do not insure their workers. A big hospital executive fretted that the law would close single-doctor offices and small-town hospitals across the state. The imperiled community hospitals have been a lament all over the country since the health-care debate began.
In his little session with county officials last week, U. S. Rep. John Boozman raised it as his big concern. He said the law would hurt hospitals in rural Arkansas and set back economic development. "In a situation where the economy is so fragile, why do you do these things?" he asked.
Boozman ought to talk to his rural hospital administrators in north Arkansas. They were the biggest champions of the health-reform law. The Arkansas Hospital Association lobbied for it. The Patient Protection and Affordable Care Act is a lifesaver for small hospitals, and big ones, too.
What the hospitals couldn't stand, one Arkansas administrator told me, was for the country to do nothing. The uncompensated care at Arkansas hospitals rose 208 percent between 2000 and 2008 and bad debts are accumulating faster every year, which hospitals recoup the best they can by raising the charges on insured patients. If they can hang on until 2014, most of the uncompensated care will vanish. Poor adults and children will all be covered by Medicaid and people above 133 percent of poverty will get private insurance, with government subsidies.
This year, more than $600 million in charges for hospital care will go uncollected. That does not include the big charity hospitals, the University of Arkansas for Medical Sciences and the Arkansas Children's Hospital, which get special federal help and huge appropriations from the legislature each year to cover their vast amount of uncompensated care. The health law will be a bonanza for community hospitals and the state-subsidized hospitals.
But somebody will have to pay for all that charitable care, won't they? Sure they will, but few of them are in Arkansas.
One hospitals executive was shaking his head this week over the opposition. "Our current system is not sustainable and everyone knows it," he said. "Companies cannot continue to absorb the rising costs, so more of them every year in Arkansas are dropping or reducing coverage or shifting more costs to workers. Over the long haul, hospitals are not going to be hammered by this law but they are going to be better off."
Hospitals are taking an immediate lick but not owing to the health reform law. Congress forestalled a long-scheduled reduction in Medicare payments to doctors by reducing hospital payments. The health reform law will eventually fix that. And those small-town family doctors who will go out of business? Arkansas's 2,900 overworked and underpaid primary-care doctors will qualify for a 5 to 10 percent bonus under the law. Boozman should ask them if they'd like to repeal the law. Arkansas has too few primary-care doctors in the rural reaches. The new law provides subsidies to increase the number of doctors, nurses and dentists in underserved areas, which embraces much of Arkansas.
It is true that insurance companies may and probably will seek some increase because the law will end their most unpopular abuses. Companies can no longer deny coverage to chronically ill children, cap lifetime benefits, cut off offspring below the age of 26 or deny coverage based on pre-existing conditions, so insurance companies will want to cover those extra costs.
But they can't pass on premium increases if they spend more than 15 percent of their premium income (20 percent for small-business plans) on overhead and profits. Some now spend as little as 60 percent of premium income on actual care.
Arkansas Blue Cross Blue Shield, which writes about 75 percent of the private coverage in the state, analyzed the law in its latest brochure to its customers.
A Blue Cross policy expert said the positives about the law were that the country finally had addressed the lack of access to health insurance by a large part of the country and that many people who cannot afford it will get help. He added: The biggest positive is that "we can now focus on other major issues, like cost and quality." It didn't sound like Blue Cross wanted the law repealed.