FAIRMONT - Insurance agents, health care professionals and local business owners comprised the audience gathered Thursday in Fairmont to hear author Dave Racer speak about the Affordable Care Act of 2010.
Racer, a self-described conservative, readily acknowledged he did not support President Obama's health care bill in the past, and he does not think it will work in the long run. That said, with Obama winning the re-election, Racer believes people need to be prepared to move forward to try to make the reform work.
The No. 1 priority of the act is to reduce the uninsured rate to zero, according to Racer, but there are some significant challenges that come with that goal.
One of the obstacles is time.
Starting Jan. 1, 2014, if an employer does not offer insurance, or doesn't offer what's considered affordable insurance, employees will be able to buy health insurance directly through an Affordable Insurance Exchange, which is supposed to provide a variety of choices for benefits and costs.
States have the option of creating their own customized insurance exchange, which must be approved by state lawmakers, meet federal guidelines, and be available to the public for open enrollment by October 2013. The alternative is to let the federal government set up a state's health insurance exchange.
In Minnesota, Gov. Mark Dayton has started the wheels moving to implement a customized plan when he submitted an exchange blueprint to the federal government last week. Here's where the time crunch comes in, as explained by Racer: Next month, Dayton plans to start meeting with legislative leaders. In January, a bill will be introduced. The governor's goal is to get the legislation approved by March 31. The problem is the federal government still has to approve the bill, and then various Minnesota departments need to write the rules, all of which have to be in compliance with federal regulations.
"Will we make it? Will anybody make it? I'm skeptical of that," Racer said. "I think they'll have to push the deadline back."
In the meantime, many questions will have to go unanswered. In Minnesota's exchange blueprints, Racer cited repeated use of "depends on" and "awaiting guidance" clauses, simply because the information is not yet available.
There are also several assumptions regarding the implementation of the newly reformed health care system that make Racer uneasy, like that thousands of state and federal employees will be hired, trained and competent by the deadline, or that the software people will use to choose their health care plans will be as user-friendly as an Internet shopping site.
Here are a few other potential problems Racer cited:
o The nature of the uninsured. About 9 percent of Minnesotans are uninsured, for various reasons. About 60 percent of those people qualify for plans, but opt not to sign up. Under the Affordable Care Act, the first-year penalty for failing to sign up for health insurance is $95, and will increase to a maximum of $2,000. Racer questions how effective that penalty will be, compared to what people will save by going without insurance.
o Thirty-some states' refusal to cooperate, a factor the federal government did not consider.
o The cost to create health insurance exchanges. California has spent about $236 million; Vermont $122 million. And Minnesota is estimated at $54 million by the time its exchange is complete, plus an additional 81 employees.
o The shortage of health care providers. Having a health care plan is not the same as getting quality health care, when the nation has such a short supply of family medicine physicians.
o The role of insurance agents and health care "navigators," who will assist people with signing up for health insurance.
One frequent question Racer faces is how much premiums will go up. Again, the answer isn't clear. Racer recommended people take advantage of a health reform subsidy calculator available online through the Kaiser Family Foundation at healthreform.kff.org/subsidycalculator.aspx
Fairmont Area Chamber of Commerce sponsored the event, with attendees receiving a copy of Racer's book, "Comprehensive Healthcare Redesign: 25 Keys to Redesign U.S. Healthcare."
Bob Wallace, director of the Fairmont Chamber, said in closing: "This health care plan, the unfortunate thing is we're all going to be paying more, and it does nothing to reduce the federal deficit."