Center for Improving Value in Health Care
Dec 5, 2012 | 3 comments | Posted by Philip B. Kalin
Controlling Costs, Coordinated Care, Integrated Care, Payment Reform, Triple Aim, Decision, Supreme, Collective Impact
Recently I spoke about Obamacare to two different community groups. My expectations of each group were different given their locale – one was in well-to-do neighborhood that trends quite red at the voting booth (I was braced for anything up to and including a death panel discussion) and the other was in central Denver which I guessed would be more progressive in tenor. It turns out that the conversations were nearly identical and characterized by a striking polarity in which nearly everyone simultaneously viewed Obamacare with hope and fear. Lack of any real understanding of the details was the other common denominator. From the questions and comments of nearly 75 people, I identified only one person who actually seemed well versed in the Affordable Care Act (ACA) legislation.
Most everyone started with a personal story about the difficulty and expense families had with getting, keeping and affording insurance. They seemed to either have experienced problems with pre-existing conditions and unaffordable coverage or ascribed those problems to the situation of family members. I couldn’t help but marvel at why more people weren’t in support of Obamacare, if only for eliminating pre-existing condition restrictions, removing lifetime caps on payments and gaining affordable coverage.
At the first meeting, I took the comments to mean I’d found kindred spirits who shared my aspiration for affordable and available coverage. I then started expounding on the virtues of the 32 million new enrollees that Obamacare was designed to bring into coverage. I had misread my audience. Their hope quickly turned into fear that 32 million newly insured combined with too few doctors to see the influx of new patients would mean their families would get squeezed out. Little comfort was taken when I talked about 25% of waste in the system that can be removed with thoughtful, coordinated delivery system approaches and how systems and providers can adapt to take on additional covered lives.
They weren’t convinced by a long shot. The sense was that we shouldn’t plunge into expanding coverage nearly so quickly. The ACA strategy won’t be an easy sell.
The other common denominator I noted was a near total lack of understanding on what Obamacare is designed to do or will provide. While the audiences knew that pre-existing conditions might be covered, there was no understanding of health insurance exchanges, coverage subsidies or the benefits of being able to get more affordable coverage. By a show of hands, 75% of the attendees believed that all 32 million new enrollees were going to be covered by government insurance. There was no concept that Obamacare is the largest-ever expansion of private health insurance.
Many believed that the cost of insurance would sky-rocket and cripple small businesses. More than a handful focused on the “panel of government bureaucrats” cutting benefits and withdrawing care for the elderly. My assurances and ACA facts may have made a slight dent but the “terror hooks” of those opposed to Obamacare have been driven in deep and it will take quite a while to change that dynamic.
From these recent experiences I stand firm in my belief that those of us who are knowledgeable and passionate about universal coverage and transforming health care can’t be so timid about what is very good about Obamacare. Papa John’s CEO John Schnatter recently received a lot of media coverage over his fear about what Obamacare will do to his business model – the estimate is that ACA mandated coverage will add $0.11-0.14 to each pizza. I say, bring it on because I know that any of us with insurance are already getting hit with that much and more through the cost shift of the uninsured.
Another CEO right here in Denver brought up the cost to Colorado of the Medicaid expansion, particularly after the feds quit their 100% subsidy in a few years. He said it will raise taxes in Colorado. He may be right but ignores the costs we are already paying for those without insurance. We need to bring these hidden costs into the open and counter fears with information. We have a lot of work to do.
About the Author: Phil Kalin is CIVHC's President and CEO. Contact him at firstname.lastname@example.org.
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