By SCOTT WEISSER
THE GOSHEN NEWS
GOSHEN — The battle over Obamacare continues. It’s also moot, in the view of one observer.
“The whole argument about defunding Obamacare in Washington was always kind of silly, because the train has left the station,” said Mark Rust, managing partner of Barnes & Thornburg’s Chicago office. “It’s headed down the tracks. ...In terms of this whole process going into place, it’s been planned for three years and it’s going down the track. And now we all have a front-row ticket to the chaos.”
Rust was part of a panel discussion Tuesday morning in Goshen aimed at making some sense of that chaos. The event — focused on the health care law’s impact on employers, consumers and providers — drew nearly 100 businesspeople to Boscos Place.
Rust pointed out that the law’s employer mandate has been put off for a year, taking some pressure off those employers.
“You get another year to study this law,” he said.
Rust explained that the health insurance exchange is for people who don’t have insurance through their employer. He said it’s opened up an idea employers like — moving from the idea of a defined benefit to a defined contribution. Basically, employers would give their workers a financial credit to buy their own insurance. According to Rust, this gives employers more control over how much they spend, and how much it increases.
Companies including Walgreens and Sears are going this route, Rust indicated, and other businesses will be watching.
“Perhaps by the time the employer mandate kicks in a year from now, there will be a lot more employers who are getting into the business of private exchanges,” he said.
The health care law will impact care providers on a few fronts, according to Laura Seng, partner in the healthcare and corporate department of Barnes & Thornburg.
“(Providers are) the ones who are out there delivering the care, and in a lot of places they are also the employers of an awful lot of people who are now trying to figure out what they’re doing with health insurance,” Seng said. In an area like Goshen, she said, health care providers make up a significant part of the economy.
“What happens to them ripples through and affects everyone in the community from an economic standpoint,” she said.
Seng and Amy Floria, chief financial officer of IU Health Goshen Hospital, also had words of caution for consumers shopping for health insurance plans. The issue is people going with the cheapest option without taking the longview.
After the meeting, Floria voiced her concern that when consumers go to the website healthcare.gov and look at the plans available in their area, they will look solely at the premium they have to pay for coverage and not at the total coverage that option is providing. She said the mistake can be made that in buying the cheapest premium, the out-of-pocket expense could be much larger when consumers actually go to use their coverage.
Floria said another thing consumers need to take stock of is where they’re going to access health care, and if they have an established relationship with a health care provider. They need to make sure that provider is in the plan they pick, she said. Floria said she’d hate to see someone go with the cheapest plan, and then learn the doctor they’ve seen for 20 years isn’t in it.
Will they go for it?
Rust also discussed health care consumers, and what they may or may not be willing to accept in their coverage. He noted that insurers have been experimenting with “narrow networks.”
“When there’s a lot of competition in a marketplace, and you want to get a lower-priced product, you choose a smaller group, a smaller band of providers, and that way you’re able to get a lower-priced product,” Rust said. “It may not be a good product, from a consumer perspective, but that’s the marketplace. (Insurers are) going to find out whether these narrow networks are things people are willing to suck up and deal with just to save money, or whether they’re going to demand a wider array of physicians and services.”
Rust also highlighted what he termed an underreported aspect of the Affordable Health Care Act saga. He indicated more than half the states aren’t planning to participate in Medicaid expansion.
“This is an extraordinary thing,” he said.
Rust said the federal plan had been to fund 90 percent of Medicaid expansion, with states paying 10 percent. If states didn’t want to pay, the feds would take away all Medicaid funding.
The U.S. Supreme Court upheld the health care act, Rust said, but stuck down the mandatory nature of Medicaid expansion. Basically, Rust said, “Congress can’t use its spending power to act to cause states to do something out of duress, to give them a deal they can’t refuse.”
The upshot was that a number of states opted out of the expansion.
“Some of it was anti-Obamacare, some of it was Democrats and Republicans saying, ‘I just don’t think we have 10 percent of that huge amount of money,’” Rust said.
Only 23 states have committed to expanding Medicaid. According to Rust, that means a large number of people the Affordable Health Care Act was supposed to take care of won’t be covered.
“Whether you think that’s good policy, bad policy, whatever, it’s a fact,” he said.
At one point during the forum, and audience member asked how the average person was expected to make sense of how the health care law works. Amy Kanouse of MDwise, a not-for-profit health care organization, said the group is planning a series of “learn and enroll” events.