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MFH works to repair 'disconnect' of reform

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Of more than 120 meetings statewide in the last two years, the Missouri Foundation for Health’s Nov. 14 town hall meeting at Missouri State University was the largest yet.

About 130 people filled MSU’s Plaster Student Union ballroom to voice concerns and learn more about the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010.

“We’ve found people are against the law, but when they find out what is included, they support those ideas,” said Thomas McAuliffe, a policy analyst with the Missouri Foundation for Health. “That shows us there is a fundamental disconnect between opinion and understanding of the law.”

MFH, which promotes equal access to quality health care in 84 Missouri counties and the city of St. Louis, is working to educate people about reform.

“We have the experience and the information to help people come to their own conclusions,” he said. “That is what this is about – understanding and empowerment.”

One reform issue garnering plenty of attention is coverage mandates, which are particularly concerning to small businesses. Under reform, small businesses – defined by the act as having 50 or fewer employees – are not required to provide health insurance for employees, but they will have access to more affordable care, with the creation of federal subsidies and health insurance exchanges.

Exchanges would be designed as points of contact where consumers could access a range of coverage options as well as insurance pools for individuals and businesses, providing greater purchasing power.

“The exchange is fairer for patients, but also lowers costs,” McAuliffe said. “Grouping businesses together increases their buying power, giving them access to group rates. Grouping buyers into a huge pool spreads risk over millions of people, so the illnesses of the few are paid for by the premiums of most.”

The individual mandate included in ACA is one of the most widely disputed issues among health reform debates.

For instance, an appeals court in Atlanta voted down the individual mandate as unconstitutional. A judge in Michigan upheld the minimum insurance requirement as a “reasonable means” for addressing economic decisions regarding health care, noting those with care plans ultimately pay for citizens receiving care with no insurance. An appeals court in Cincinnati also upheld the mandate as constitutional.

The U.S. Supreme Court announced on Nov. 14 they will rule in March on their interpretation of health reform’s constitutionality.

“The Supreme Court is very political,” said Mark Rushefsky, political science professor and director of the Master of Public Administration program at MSU. “All you have to do is look at the lower courts rulings. Those ruling unconstitutional are Republicans; those ruling constitutional are Democrats.”

Supreme Court arguments are usually limited to one hour, but justices have allotted the health reform case an extra 4.5 hours.

Rushefsky said the extra time likely means the court is focusing on more than just the insurance requirement issue.

Penalties for not carrying health insurance are another aspect of reform generating interest – and questions.

Beginning in 2014, most people – excluding those with financial hardships or certain religious beliefs – will be expected to carry insurance or pay fines, which start at $95 the first year and increase each year of noncompliance to $625 or 2.5 percent of income after four years.

Subsidies will be available for some people, including employees of small businesses not offering insurance, if  those employees meet financial requirements.

Reform also is bringing changes to Medicare. Under reform, hospitals can become accountable care organizations, working with Medicare on a platform where providers and hospitals share profits when they can demonstrate improved patient outcomes.

Since 2005, Springfield’s St. John’s Hospital, under its parent, Mercy, began participating in the Physician Group Practice Demonstration, aimed at reducing waste and improving care for Medicare patients.

“This is very important because nothing like this has been done before,” St. John’s Director of Primary Care told Springfield Business Journal in October. “They’ve always paid us for seeing patients, not for keeping them healthy.”

Under ACA, Medicare benefits will expand, preventive services such as wellness exams and mammograms are covered at no cost, prescription drugs will cost less, post-hospital care and a focus on improved management of chronic diseases will aim to cut waste.

Though Missouri Foundation for Health does not have additional town halls scheduled in southwest Missouri, the organization will schedule free public or private meetings with groups of all sizes.

“When we have a local sponsor or group to help engage the community, we’ll do a town hall,” said Michelle Miller, MFH public policy liaison. “When it’s a smaller group and a more focused discussion, you walk away learning a lot more.”

To learn more about setting up a meeting, visit[[In-content Ad]]


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