By Dr. Ted Norman
Here we are, billions of political ads later, facing the same challenges from before the election. In health care, now that the Supreme Court ruled the Affordable Care Act constitutional and it is unlikely to be repealed, the work starts on implementation and discussion about health insurance exchanges.
In simple terms, exchanges are brokers for insurances companies set up by government or private companies. In Colorado, for example, an exchange board has been developed to solicit bids from insurance companies that meet a specified level of benefits and cost. The general public can then go to the exchange and purchase insurance coverage through it. But how is this different than the current system? Because as part of the ACA, the premiums can be partly subsidized, making this a more affordable product for those in need. As is already well established, cost is one of the major barriers to insurance coverage in Colorado.
Exchanges can be developed by states, groups of states or even private companies, and if a state elects not to develop an exchange, then one will be provided by a federal program. In Colorado, the state has been developing an exchange since 2010 and has an organization in place to design the program. We are far ahead of many other states. but it still will not be selling insurance policies until 2014.
Why are some people upset about this? Simply, money. One of the fears of the exchange is that subsidies will cause a large pool of low-income, uninsured citizens to purchase insurance, which is good, but the subsidies will come out of state and federal tax dollars, which in todays political environment is bad.
In addition, the insurance companies will not sell policies at a price below the cost of health care, so if the cost of care continues to go up, then the policy costs and the subsidies rise as well. If the subsidies can no longer be funded, then the prices will be no different than in the open market.
This creates risk because the crucial issue of the increasing cost of health care is not being addressed directly.
In Massachusetts, which has had an exchange for years, health insurance policies were provided for the entire state (again, a good thing), but the cost of the subsidies is quickly draining the state budget. Colorado will need to learn from that.
Another related problem is that the country is predicted to be short 60,000 primary care providers over the next 10 years. This is due to retirements and a lack of new graduates, but will also be fueled by the increase in new patients with health insurance across the country due to the exchanges.
So it again comes down to the basic problem: we pay too much for the quality we receive in health care. In your business, Colorado, the state, and the country, the same problem exists. That solution is a debate yet to come politically, but it is inevitable.
Dr. Ted Norman is an internist with Banner Medical Group in Fort Collins and can be reached at edward.norman@ bannerhealth.com.