“So much of what’s out there is just propaganda!”
That’s what a local doctor told Lt. Governor Elizabeth
Roberts at the April 13 forum on affordable health care, organized by the Charlestown
Democratic Town Committee and held at the Cross Mills Public Library. He commended Liz
Roberts for her leadership of Rhode Island’s efforts to put the new Affordable
Health Care Act into practice and urged her to educate the public about what it
will do – and won’t do.
Lt. Governor Roberts mostly took questions and provided
straight-forward, substantive answers during the nearly two hour session. She
noted that though the new law is federal, how it’s put into play is largely decided
in each state. She also debunked, right from the start, the myth that so-called
Obamacare is “socialized medicine,” pointing out that it’s really the opposite.
It works to coordinate the existing patchwork system of health care financing
that rests largely on private insurance, plus federal Medicare and the
state-federal Medicaid program so that it works more efficiently and covers
more people.
Gov. Lincoln Chafee signs the Jan. 2011 Executive Order setting up the RI Health Exchange and putting Liz Roberts at the head of the Commission charged with setting it up |
Rhode Island is signing up health insurers who will then
offer citizens choices of plans, prices and menus of covered services (though
the federal law sets minimum standards of coverage). Starting in January, the
exchange should be up and running. Low-income people, especially low-wage
workers, have been priced out of the market, but will now be eligible for
subsidies that will make health insurance affordable (i.e. no more than 10% of
a person’s income).
The first parts of Obamacare
have already gone into effect. They include preventing health care plans from
denying coverage to people with existing conditions, and allowing young people
under 26 to be covered under their parent’s family plans.Phasing out the
Medicare prescription coverage “donut hole” that has burdened seniors and the
disabled with major drug costs has begun. The first year of the phase-out of
the “donut hole” has put an estimated savings of $8 million back into the
pockets of Rhode Island’s senior citizens.
Lt. Governor Roberts dispelled the myth that you will have
to give up your existing insurance coverage. You are free to stay where you
are, unless your coverage is unaffordable – as is the case for many low-wage
workers, such as those who work for Wal-Mart or fast food companies. If your
insurance costs more than 10% of your income, you can use the health care
exchange to get better coverage and, depending on your income, a federal
subsidy to ensure that the coverage is affordable.
For the first time, there will be coverage for adults
without children with incomes up to 130% of the poverty line. Subsidized
coverage will be available on a sliding scale up to 400% of the poverty line.
The new program gives small businesses an option to
participate and promises better coverage at cheaper rates because of the
leverage the state will have to bargain with carriers. There is also a new tax credit program for
small businesses and a subsidy program for small non-profits that add insurance
coverage for workers.
Lt. Governor Roberts also stressed that the new law not only
means more people can get health insurance but also provides the state with an
opportunity to change the way we look at the health care system. “How do we pay
for outcomes not just services?” She
said we need to look for better ways to get healthier communities.
One member of the audience said she read a book that said
that under Obamacare there won’t be any coverage for cancer care once you reach
the age of 76. Not true, said the Lt. Governor, noting that the education
program for what’s really in the new
law will launch on June 1st.
Responding to an audience question, the Lieutenant Governor
said that the current estimate for the number of uninsured Rhode Islanders is
110,000 people. She said that about 30,000 of those people are already eligible
for Medicaid, but have not yet applied. She estimates another 40,000 of the
110,000 uninsured will become eligible for coverage when Medicaid expands.
All told, she estimates that at least 80,000 of the 110,000
currently uninsured will be able to get affordable health care coverage under
the new program.
Dave Henley, a manager at the Wood River Health Center,
asked Ms. Roberts about the potential for a repeat of what happened when the
Massachusetts law kicked in. It was so popular and brought health coverage to
so many new people that doctors’ offices were swamped with people who had not
seen a doctor in a long time.
Lt. Governor Roberts said that while there could be a big
spike in demand on services when previously uninsured people get coverage, that
Rhode Island is a leader among the states in having extensive primary care
services. She said that it will certainly be “challenging” to adjust and
change, especially since the health care industry is currently around 20% of
the state’s total economy. In particular, Rhode Island law permits Nurse
Practitioners more flexibility, than Massachusetts, to provide primary care. A
doctor in the audience spoke up to praise the capabilities of nurse
practitioners.
Several members of the audience raised fears that some
employers will start cutting back workers’ hours and change their status from
“full-time” to “casual” to avoid having to provide real health insurance
coverage. Many such employers offer high-cost, high-deductible insurance with a
limited scope of services, and these types of plans will not meet the new
standards under the law.
But Lt. Governor Roberts said that employers will not be
able to dodge their legal or moral responsibilities so easily, and that all
employees, including part-time or so-called “casual” workers, will be part of
the tally when large employers’ responsibilities are assessed.
Her office is working with the state Division of Elderly
Affairs to make sure that SHIP Counselors (SHIP stands for “State Health
Insurance Plan”) fan out to local communities to sit down and talk to elderly
Rhode Islanders about Medicare, health insurance and their health care needs.
Not every question has an answer yet, said Ms. Roberts, and
some problems and concerns are still being worked out. As an example, she said
her office is still working with state labor unions whose members are covered
by multi-employer insurance plans to avoid coordination problems or potential
conflicts. She is also confident that the roster of insurers who will be
included in the state’s health care exchange will grow to the level where it
will lead to healthy competition.
The Lieutenant Governor suggested that if you want a preview
of what Rhode Island’s health care exchange will look like after its January
roll-out, you can go to the Massachusetts “Health Connector” website (click here).
Lieutenant Governor Roberts’ own website on health care
reform is also well-stocked with useful information about what’s happening now
and what will be coming. Click here.
We had the entire program video recorded. It will be shown
on Cox public access channel 18 and is also available here: http://vimeo.com/63983769. Or just click below.