Local care viewed as plus with health bill

The rancorous process that led to the adoption of health care legislation this spring presents an opportunity to communities across the nation to treat themselves for the spiraling climb of medical costs, the head of Rocky Mountain Health Plans said Saturday.

If those communities succeed, they can immunize themselves against the chance of a nationalized health care program dictated by bureaucrats, Steve ErkenBrack told members of Club 20 during the Western Slope lobbying and promotional organization’s spring meeting at Two Rivers Convention Center.

Rather than being an Armageddon or Second Coming, the health care plan is more likely a work in progress, ErkenBrack said.

Complaints that the legislation nationalizes health care fall short of complete truth, ErkenBrack said, but, “If the communities of the country don’t rise to the challenge, it will lead to nationalization.”

He and several Rocky Mountain Health Plans officials have culled the more than 2,000 pages of the health care bill signed by President Barack Obama and found a multitude of issues, but it’s also clear the framework of the legislation was constructed to encourage local systems such as what has become known as the Grand Junction model, ErkenBrack said.

The major players in the model include Rocky Mountain Health Plans, Community Hospital, St. Mary’s Hospital, the Marillac Clinic, Quality Health Network — all nonprofit organizations — and an independent physicians association.

Two major aspects of the legislation are opposite sides of the same coin, ErkenBrack said.

One part is the requirement that will, in 2014, guarantee coverage to anyone regardless of whether they have a pre-existing condition.

The opposite side of what is called “guaranteed issue” of health insurance to any purchaser is the individual mandate requiring people to purchase coverage.

Club 20 and a Colorado health care commission established by Gov. Bill Owens, a Republican, and maintained by Gov. Bill Ritter, a Democrat, recommended an individual mandate as the best way to bring additional money into the health care system and as a way to enforce personal responsibility on the part of individuals who tend to purchase coverage only when they need medical care.

Local organizations turning to models like Grand Junction’s stand the best chance of dealing with the costs from new requirements of guaranteed issue and the elimination of caps on the amount policyholders can be paid over their lifetimes.

One-size-fits-all approaches handed down from Washington, D.C., are unlikely to result in the kinds of savings promised by Congress and the president in pushing the health care legislation, ErkenBrack said.

When he told a Washington official about the transitions program fashioned to hold down hospital readmissions by following up with patients to make sure they followed medical instructions, ErkenBrack said he was told the idea was brilliant. The officials then asked him which illnesses or conditions it would apply to, so national standards could be set.

Those conditions, however, would be different in Montrose and Pueblo, he said, and couldn’t apply statewide, much less nationally. How to give local organizations the ability to find efficiencies and save money is “the million-dollar question,” ErkenBrack said, “or, I guess, the trillion-dollar question.”

The legislation includes an insurance rating system that Rocky Mountain Health Plans had sought, one that will allow it to spread costs over greater numbers across Colorado, ErkenBrack said.

The legislation, however, falls short of the need to control costs and includes no provisions to rein in litigation against physicians, hospitals or other health care providers, he said.

Ultimately, “The cost-saving measures have to be delivered on the ground, not by act of Congress,” ErkenBrack said in a separate interview.

The changes, however, do offer the opportunity for individual purchasers of insurance to compare various products through the insurance exchanges that the bill authorizes. Purchasers will be able to compare different carriers’ offerings of bronze, silver, gold and platinum plans and decide which one they prefer, ErkenBrack said.

The legislation still falls short of enforcing personal responsibility by allowing some to pay penalties of as little as $95 a year for failing to purchase health insurance, he said. Even though that penalty could rise as high as $695, “There is still a question as to whether that is a meaningful deterrent,” he said.

Making the legislation work will require bipartisan and nonpartisan effort aimed at giving local organizations unfettered opportunities to cut cost while meeting medical needs.

“The question is: Is the bill going to be implemented in a way that will let communities excel?” ErkenBrack said. “Or will Washington superimpose its own requirements and regulations?”


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