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Presentation stresses importance of expanding health insurance
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Carolina Meadows

Carolina Meadows residents receive periodic briefings on issues impacting their health and wellbeing. A resident committee chaired by Dr. Ernest Krayblll coordinates this Medical Update Series.

Recently Dr. Pamela Silberman, President of the NC Institute of Medicine, updated us on the new Affordable Care Act (ACA). An analyst at the UNC Cecil Sheps Health Policy Center, Dr. Silberman is also an advisor to our state for the Act’s implementation.

Her clear and informative presentation reinforced why I believe expanding insurance coverage is a high priority for our nation.

I still remember vividly my experience as an intern in the Chicago Cook County hospital 50 years ago when I had to tell a father his 12-year-old daughter had died from a severe complication of diabetes. A medical resident and I had worked all night trying to overcome the severity of the child’s metabolic disaster. She should have been seen and cared for much sooner, but the family was without medical insurance and had been turned away from their community hospital.

There is no doubt that the lack of insurance leads to delays in diagnosis today. As a radiologist, I see it when a perforated appendix should have been diagnosed a week earlier, but the insurance-less family doesn’t come in to the emergency room until their child is vitally sick and peritonitis has set in. I hear about the lymphoma affecting the spinal cord of an accomplished violinist, also without insurance, who is diagnosed too late for cure.

The Affordable Care Act may help, but it is multifaceted and complex. Three of the law’s major provisions are: 1. A mandate that most citizens buy health insurance; 2. Establishment of health benefit exchanges; and 3. Insuring those with preexisting conditions.

An estimated 1.7 million non-elderly North Carolinians are uninsured. To establish government offices that require and monitor the purchase of health insurance by 2/3 of 45 million people in the United States by 2014 as required in the law will be formidable. Considerable uncertainty exists about the mandate, which may be declared unconstitutional by the Supreme Court.

The establishment of Health Benefit Exchanges by the states — or by the federal government if the states don’t – will take time. It is not clear that all the uninsured can go online or know how to decide which commercial insurance plan is best for them. Certainly help will be required from the state, employers, or a physician’s staff.

Dt. Silberman believes the segment of the law requiring insurance companies to insure those with preexisting illnesses will be maintained even though the mandate fails. Needless to say insurance premiums will be raised – or already have been – to cover applicants with a previous illness.

Other provisions of the bill include major funding ($2 billion by 2015) for prevention, wellness and public health activities and 1.5 billion dollars over five years to encourage and support medical providers for underserved areas. The ACA will help the Department of Health and Human Services establish a strategy to improve health care quality. The medical safety net is to be improved with money for construction or renovation of hospitals and health centers. Patient readmission rates for hospitals to determine the effectiveness of initial treatment will be examined.

The bill will be a challenging undertaking and oversight in time and money by many people. To implement the bill the Congressional Budget Office projects a cost of $938 billion over ten years. Can it be that new revenues from those now uninsured and spending cuts will work? In our present hard economic times we may not be allowed to try it, especially in the next election cycle. I personally think it would have been better to use the template of Medicare even though we might have had to raise premiums and pay more for reasonable costs.

It is imperative that we improve the health and wellbeing of the nation. That is as important as improving the infrastructure of our schools, bridges, and roads.

From Dr. James Scatliff, a resident of Carolina Meadows

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