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Trusted local news leader for Prescott area communities since 1882
6:53 PM Sun, Sept. 23rd

Talk of the Town: Patient protection and affordable health care

The federal health care law continues to puzzle many of us as we are beset by rumor, fiction and agenda-driven pseudo facts.

State Sen. Krysten Sinema, the only Arizona legislator to have worked on writing this law, clarified these misconceptions in a presentation to about 125 persons at Prescott United Methodist Church on March 20. And, yes, she has read the law! Pending lawsuits non-withstanding, the law continues to be implemented.

Because Arizona covers people up to 100 percent of the poverty level, increases in federal payments will save Arizona 2.3 billion over the next 10 years of AHCCCS costs. The federal government will also allow Gov. Jan Brewer's plan to strike 250,000 persons from AHCCCS, the number added when voter's initiative 204 passed. However, elimination of proposition 204's provisions without voter's consent violates the state constitution and will possibly bring an expensive lawsuit. Currently, Arizona spends about $1 billion on health care and receives about $8 billion from the federal government. All Arizona has to do is maintain current programs, and we will be able to keep these savings.

The Medicare, Part D, prescription drug "do-nut hole" will be diminished by $250 per year until it disappears. Also, insurance companies can no longer deny coverage to children with preexisting conditions, and dependent children can stay on their parent's policies until age 26. In addition, the law prohibits placing "life-time limits" on your coverage, and insurance companies cannot rescind coverage if you get sick. The law also provides some free preventive care, thus keeping many people out of expensive (eleven times the cost of elective care) emergency rooms, reducing medical costs for all.

Small businesses (50 or fewer employees) will not have to provide insurance, but if they do, they receive tax credits of up to 50 percent of their costs.

In 2011, Medicare patients will receive free preventive care for items such as prostate tests, mammograms, and diabetes tests, again reducing costs. Also, insurance companies will be required to spend 85 percent of your premiums on medical care, whereas some companies now use 30-50 percent of premiums for overhead and profits. States may implement home and community-based services through Medicaid rather than requiring expensive nursing home care, another savings with better outcomes.

In 2014, states may create American Health Benefit Exchanges where individuals and small businesses may purchase insurance, thus placing them in insurance pools where group plans are cheaper than going it alone. A family of four earning $88,000 or less will receive cost sharing savings. Also, insurance companies will no longer be able to place an annual limit on the dollar value of your coverage. States will be able to form "health care choice compacts" with other states so policies may be sold across state boundaries, increasing competition and driving down costs.

The federal government will help phase-in costs for the currently uninsured, and Arizona will receive $2.5 billion in increased funding, between 2014-2019, for AHCCCS. Arizona will also receive $130 million for Kid's Care (2016-2019).

Cost savings will be accomplished by eliminating waste, fraud and abuse in Medicare and Medicaid, and by expanding the Medicare payroll tax to include unearned income (investment income) for the top 2 percent of earners ($250,000 per year). Does your family earn $250,000 per year? Could you afford a 1 percent increase in your payroll taxes if you did?

The law is being phased-in over nine years in order to be done carefully. Along these lines, there are, in fact, provisions for medical malpractice reform! Nine states are running reform programs through 2012, and best outcomes will be used to implement malpractice reform in all states thereafter.

The most critical provision for many is that insurance companies will no longer be able to turn you down because of preexisting conditions, the very conditions for which you need insurance! It is because of this provision that the law requires the currently uninsured to get insurance or be fined. If this were not so, any healthy, young person could go for years without insurance, knowing they could not be turned down when illness struck. Those with insurance would be the sick and elderly, making insurance prohibitively expensive. If we're all insured, average costs drop from current levels.

And, finally, doing nothing (if the health care law is rescinded) leaves us with a financially unsustainable health care system where premiums go up every year, a system that is the number one cause of family bankruptcies in the United States.

For a far more detailed power point, go to ksinema@azleg.gov.