Details 
of health 
care put 
into fore

With the results of the election in the rearview mirror, Coloradans can:

A) Breathe a sigh of relief that they won’t be treated to any more political health care commercials;

B) Chill out knowing that health care as a political issue is no more;

C) Relax in the knowledge that the hard decisions have been made; or

D) None of the above.

Go ahead, think about it. No time like the present.

Ready?

If you said D, you are correct.

If you answered yes to any of the other options, well, you might want to get checked out by a competent physician. Start by verifying the presence of a pulse.

And if you have one, get used to the reality that health care is likely to demand more of your time, not less, and, yes, it’s likely to be more complicated, not less.

Here’s the post-election deal: The results of Tuesday’s election didn’t push health care to the background. At least in Colorado, it’s going to be front and center through 2013 as the Colorado Health Benefits Exchange takes shape.

And no, the politics of health care aren’t going away.

While many saw the results of the re-election of President Barack Obama as a ratification of his signature legislative achievement, the House remained firmly in Republican control, setting the stage for continuing tussles over the legislation.

In the face of continuing, if somewhat lessened uncertainty, there’s one imperative, said Randy Pifer of Active Insurance Solutions in Grand Junction: Get a doctor.

“People certainly need to secure a physician relationship,” Pifer said. “There will be a number of people who will be coming under an insured plan in the near future. People who don’t have a relationship with a primary-care physician will be looking for one.”

People might also find themselves not in the market not only for a physician, but for insurance coverage itself, and do so on their own.

As providers, insurers, patients and others have explored the extent and limit of the new law, one thing they’ve found is that for some employers, it could make financial sense to stop providing health insurance coverage for their employees and to pay a fine to the federal government — $2,000 a head for employers of 51 people or more — and save cash in the bargain.

“I do feel a lot of employers will drop their coverage outright,” Pifer said.

Certainly the idea has occurred to many.

“Since we’re partially self-insured, we’re not considering it,” said Dan Roberts, vice president of finance and administration at Mays Concrete Inc. “Obviously, though, the thought had crossed our mind.”

Hilltop Community Resources in Grand Junction likewise has looked at the potential for better managing its health care dollars that way, Hilltop President Mike Stahl said.

By paying fines amounting to $1 million, Hilltop might be able to pay its employees more from the remainder of its $2.3 million health insurance budget and turn them loose to buy insurance through the state exchange.

“What stopped us and a lot of employers is that we know that there is a percentage of employees with pre-existing conditions and they couldn’t get insurance,” Stahl said. “That will be changing under the new law, which opens up a new layer of conversation.”

Colorado, as it happens, is ahead of most states in establishing its exchange, which is supposed to go live on Jan. 1, 2014.

That means it will need to be open for enrollment by Oct. 1, 2013.

Though the start date is a national one, Colorado is one of the few states making progress toward meeting it, said Steve ErkenBrack, a member of the exchange board of directors and the head of Grand Junction-based Rocky Mountain Health Plans.

Many states have opted out of building their own exchanges and are waiting on a federal insurance exchange, which also is to go live in 2014.

One term to which consumers will be introduced is that of a “navigator,” a person whose job it will be to aid consumers in evaluating the offerings from companies participating in the exchange, ErkenBrack said.

“We’re well ahead of the bell curve of numerous other states,” Pifer said. “Nobody wants to be involved in a federal exchange.”

Some employees also could lose their jobs, or at least see their hours reduced, as employers move to cut costs for full-time employees by limiting hours to less than 30 a week. Pifer said.

Coloradans can expect to see a conspicuous effort in the coming year to make them familiar with the idea of an exchange. 

Next year, Coloradans will see the exchange marketed on television, in ads as they cruise the Internet, in print publications such as newspapers and by grassroots organizations, Myung Oak Kim, spokeswoman for the benefits exchange, said in an email.

Think of an exchange as an Internet marketplace such as those that help consumers make travel plans, said Dr. Michael Pramenko, a Grand Junction physician.

“You can go online but instead of Travelocity, you have Insurance-ocity,” Pramenko said.

Participants in the exchange who earn up to four times the poverty level will be eligible for federal subsidies for their insurance premiums. For a family of four, that’s an income of $88,000 a year.

Development of the exchange will move forward against a backdrop of political wrangling as the president and the Democrat-dominated Senate deal with the Republican-led House.

The fate of the law might not yet be sealed, said Dr. John Oster, a Grand Junction ophthalmologist, who noted the deal isn’t sealed “if Congress decides not to fund it.”

New rules determining the conditions under which procedures can be undertaken will result in delays for some surgeries, such as removal of cataracts, Oster said.

That’s going to result in the rationing of health care, Oster said, leaving federal panels to “determine who lives and who dies and whose life is worth saving.

“People do not know what they voted for when they voted for it,” he said.

It’s not rationing, Pramenko said, because the new law doesn’t prevent patients from paying for their own procedures.

Preventing patients from choosing — and paying themselves — for more expensive treatment would amount to rationing, Pramenko said.

But if a patient wants the more expensive of two equally effective treatments “don’t expect your fellow Americans to pay for it,” Pramenko said. “You can get it. It’s still a free country.”

Albeit a more expensive one, Pifer noted, pointing to new taxes that are now clear to go into effect, including taxes on medical devices, some transactions such as home sales by high-income earners, and other costs.

One shortfall of the Affordable Care Act is a lack of ways to reduce actual costs, Pramenko and ErkenBrack both noted.

“At the end of the day health care has to be affordable,” ErkenBrack said, noting that if cost-reduction measures are undertaken, lower-income people who make use of the exchange will be unable to afford premiums, even with the aid of federal subsidies.

That will mean finding ways to continue providing services to the 10 percent of the population that is driving 85 percent of health care costs, without reducing quality, ErkenBrack said.

And finding ways to lower some expectations for the law as it goes into effect.

“Contrary to popular belief,” Pifer said, “it’s not going to cover 100 percent of everything.”


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