Almost two years after becoming law, health care reform remains embroiled with politics and cloaked with uncertainty, while the details of how the overhaul will materialize remain hazy.
Last week the White House proclaimed that several states are moving forward with implementing the new law, which will require all Americans have health insurance beginning in 2014. For states like Montana that have been resistant to the reform, the Obama administration has begun creating federal backstops that are scheduled to go into effect two years from now.
Montana in many ways embodies the fractured landscape of health care reform. The state did not join 26 others in asking the U.S. Supreme Court to overturn the law, but at the same time rebuffed it by not establishing a state-run health insurance market, or exchange.
According to a Lee Newspapers poll released last March, 57 percent of Montana residents wanted the federal law repealed while 34 percent were in favor of keeping it. Many state lawmakers have decried the overhaul and its mandate for everyone to have health insurance and have campaigned for its repeal. Other state officials have said misinformation and confusion have muddied the law’s benefits.
Democratic Sen. Max Baucus, one of the architects of the federal health care law, remains supportive of the Patient Protection and Affordable Care Act that President Barack Obama signed into law in March 2010, and sees the benefits eventually quieting the criticism.
“There is no question in my mind that the steps we took to protect Montanans and lower skyrocketing costs in the health care law were monumental – but more importantly they were the right thing to do,” Baucus told the Beacon.
“I have no doubt that as more and more folks begin to take advantage of the new protections and tax cuts in this law, more and more folks will realize just how important it is for Montana,” he added.
Twenty-six states have challenged health reform through a filing in the Supreme Court. The core of this challenge is the mandate that requires all Americans to buy coverage or pay a penalty.
“That the Supreme Court is taking this up, I think, is a positive signal that there are legitimate concerns surrounding the constitutional aspects of mandating that individuals purchase health-care insurance and purchase it according to Washington’s guidelines,” House Majority Leader Eric Cantor of Virginia said in an Associated Press story in November.
The decision could impact several provisions in the health care law and lead to their removal. In the meantime, some provisions in the new law have already taken effect while others continue to materialize.
New health insurance markets, or exchanges, are being established either by states or the federal government and will begin Jan. 1, 2014. Also at that time Medicaid eligibility will be fully expanded for low-income adults.
Another provision already in place is access to free preventative services like mammograms and colonoscopies for seniors with no out-of-pocket costs. Young adults can now remain on their parents’ health insurance plans until age 26. The Patient’s Bill of Rights has been expanded as well.
Health insurance companies and medical institutions are currently making changes in accordance with these provisions despite the uncertainty surrounding the Supreme Court’s decision, which is expected to come in June.
Blue Cross Blue Shield of Montana, the largest health insurance provider in the state, traveled to several cities in recent months and hosted informational sessions to try to explain how the reform will affect consumers.
The company has worked with providers and the state auditor’s office to develop Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO).
“Our focus on PCMHs is designed to help our members get the appropriate primary care, along with prevention and wellness,” Frank Cote, senior director of government relations for Blue Cross Blue Shield, wrote in an email.
“Implementation of ACOs will focus on the ‘triple aim’ of health care: quality of care, patient satisfaction, and total cost of care.”
Understanding the specific elements of health care reform can be difficult, and State Auditor Monica Lindeen, a Democrat, tried to clear up any confusion associated with reform at the annual Chamber of Commerce Business Days gathering in Helena last week.
“Everybody is very curious to know where we stand and where we’re going,” Lindeen said in a later interview. “There are a lot of unknowns at this point as we’re waiting to see what happens with the Supreme Court decision and with the elections.”
Lindeen said a lot of confusion surrounding health care reform is because of its political nature.
“Any time you pass an initiative that is this big, nobody’s going to be 100 percent happy,” Lindeen said. “But there’s a lot of great things in this that really do affect consumers in a positive way. Unfortunately not everybody knows what those positives are because they’re hearing instead all the misinformation.”
Lindeen, whose office regulates insurance, campaigned with a group of stakeholders representing insurance and medical officials in support of a bill proposing to create a state-run exchange heading into the most recent legislative session in Helena. State lawmakers rejected the bill and, as a result, the federal government is creating an exchange that will be federally facilitated.
Twenty-eight states have so far agreed to build their own state-run exchanges. These exchanges, which will help residents compare and purchase taxpayer-subsidized private insurance coverage, are a cornerstone of the health reform law.
There are roughly 168,980 residents in Montana without health insurance, or 17.3 percent of the population, which is tied for the 14th highest percentage in the country, according to the latest data compiled by the American Community Survey and the Kaiser Family Foundation, a nonprofit, nonpartisan nationwide medical research foundation.
About 44 percent of Montana residents, or roughly 422,900 people, receive health insurance through employers, according to the Kaiser Foundation. Medicare is the second-highest provider of insurance coverage in the state at 16 percent, or 152,100 people, followed by Medicaid at 13 percent, or 128,000.
While the percentage of uninsured residents is slightly above the national average, health care spending in the state is slightly below. The average individual in Montana pays roughly $6,640 a year. On average, 42.8 percent of that spending goes toward hospital care, 25.5 percent covers physician and other professional services and 11 percent goes to prescription drugs and other medical nondurables.