GOP takes run at health reform laws

January 7, 2011
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Two Michigan Republicans are stepping onto the national stage as Congress prepares for a vote, scheduled for Wednesday, on the repeal of health care reform.

With the GOP claiming House leadership positions as the new Congress was seated last week, U.S. Rep. Fred Upton, R-St. Joseph, and U.S. Rep. Dave Camp, R-Midland, took on powerful roles. Upton is chairman of the Energy and Commerce Committee, and Camp is chairman of the Ways and Means Committee.

The pair is among those leading the GOP charge against the Patient Protection and Affordable Care Act of 2009.

Michigan Attorney General William Schuette announced last week that he will continue Michigan’s role in legal challenges filed by 20 state attorneys. They target the requirement that people purchase health insurance and the expansion of Medicaid. Legal action against health care reform began under former Attorney General Mike Cox.

Despite the Republicans’ claim that voters gave them a mandate, public opinion on health care is divided, according to a January report from the nonpartisan Kaiser Family Foundation.

In polling at the end of 2009, the foundation found that 42 percent of Americans held favorable views of health care reform; 41 percent held unfavorable views; and 18 percent had no opinion. The results have been similar for eight months, the foundation said.

The poll highlighted the partisan nature of opinions on reform. Among Democrats, 66 percent preferred to leave reform as it or expand it; among Republicans, 55 percent backed total repeal.

When asked about six reform provisions, a strong majority of respondents wanted to keep five, but 68 percent favored repealing the individual mandate.

Wednesday’s vote is symbolic, with the repeal bill facing guaranteed death in the Democratic-controlled U.S. Senate or on the desk of President Barack Obama. But local health care experts and leaders polled by the Business Journal say that with time, GOP House leadership could pick off or tie up portions of the law with tactics such as committee hearings and funding stalls.

Whether histrionics in D.C. can produce good health care public policy for West Michigan is the question, they say.

Lody Zwarensteyn, president, Alliance for Health:

“It’s grand theater that’s going nowhere…This thing really, right now, is a farce where the parties are using it and plying these issues in their desire to have the White House. I’m disappointed that our political process is failing us. There is no rational discourse,” said Zwarensteyn, whose nonprofit organization reviews health care capital expenditures in 13 West Michigan counties and has received Robert Wood Johnson Foundation grants aimed at supporting local health care quality.

“We’ve been talking health care reform in this nation for decades, and yet costs have gone up and health care consumes an ever-increasing percent of the gross national product. You can repeal till the cows come home. What’s going to handle the real situation where the health care costs are out of line and are killing jobs?” he asked. “I’m very critical of both sides.”

Andy Johnston, director of legislative affairs, Grand Rapids Area Chamber of Commerce:

“The cost of health care always has been a priority for the business community, and it’s gone up even more so. Michigan’s current economic climate is number one, and the cost of health care is a close number two,” said Johnston, who is the chamber’s staff person for its Health Care & Human Resources Committee.

“The business community is most concerned about uncertainty. ... Our committee is going to continue to be focused on Medicaid reform. Management of the state budget is a top issue for the new administration and our members. Medicaid is one of those areas that needs to be addressed. I’d love to see the administration go after a waiver to try more innovative things with Medicaid. Federal health care reform continues to expand Medicaid in a way that will have a significant impact on the state budget.

“There’s a great deal in that bill that does need to be changed. We do need to go back to the drawing board to draft real health care reform.”

Chris Shea, executive director, Cherry Street Health Services, an 11-clinic Federally Qualified Health Center serving low-income clients:

“Of course, it, initially at least, is simply a staged act. There’s not an expectation that the Senate or the president would go along with that. But I think that there will be serious attempts at breaking up bits and pieces of the Affordable Health Care Act in the future.

“The things that are really important to people of low income in particular are expansions in the Affordable Care Act of eligibility for Medicaid. And that’s really important to us as an organization, as well, because many of the people who will be covered in the future with Medicaid, who aren’t currently, just don’t have a means of payment, and so we don’t have the resources to take care of all of them,” Shea said.

“I think the fear that comes from some is that Medicaid will gain leverage, for example, when it comes to negotiating with drug companies for favorable pricing. Medicaid will be in a better position to do that when they have a more organized system and more full coverage.

“From a service standpoint, it will be such a wonderful thing that people don’t have to figure out every little last issue that could possibly reflect on their eligibility, that it will be simplified a great deal, and basically the bottom line is there are lots of people who aren’t served now who will be served then.”

Steve Borders, Grand Valley State University professor, School of Public, Nonprofit and Health Administration:

“I think the real place to watch is going to be states, anyway, just because there’s not going to be any money. All the enhanced Medicaid funding (from the American Reinvestment and Recovery Act of 2009) is going away. Where are states going to find the money to continue services at this level?” said Borders, who previously worked for Medicaid in Texas.

“Medicaid is two-thirds funded by the feds in most states anyway. There is no way any Tea Party person is going to let them send that money to Washington and not bring it back. The Republicans have got control in Michigan. It’s going to be interesting to see what they do. It’s the blind, disabled and institutionalized populations that take up all the money.

“In the health care bill, the feds pay 90 or 100 percent of all these people coming in for the first two years. After that, it’s going to fall on the states to pay for this. That’s why everybody’s terrified. If you looked at Michigan’s budget over the last 10, 15 years, you see health care just growing and growing. It’s crowding out everybody’s state budget. The really interesting battles that are going to be fought are at the state level.”

Dominic Siciliano, sales manager, Agent Alliance Corp. and president of the West Michigan Association of Health Underwriters:

“Full repeal will not occur. Not yet. I don’t think it will ever happen. There’s a lot of pieces on the table,” said Siciliano, a former high school basketball coach.

Among them: the CLASS Act that aims to pay for long-term care insurance; the section that prohibits companies from offering plans of differing quality to different classes of employees; a provision known as 1099, which requires reporting of business transactions; the mandate that employers of 50 or more must offer insurance or face fines; and, outside of health care reform, the pending cut in Medicare payments to doctors.

“We have all these little parts of it, a gigantic puzzle,” Siciliano said.

Dr. Paul Farr, Grand River Gastroenterology and former president of the Michigan State Medical Society:

“Why are they going to do that when there’s a president who will veto it and a Senate that won’t even bring it up? I think what they are doing is for the sheer politics of it. When you’re undergoing something just for political purposes, what’s the point?” said Farr, who performs colonoscopies, one of the preventive services that PPACA now requires insurance companies to cover.

“When we see anybody that comes with XYZ Insurance, we don’t know if they have screening or if they don’t, and there are codes that have ‘gotcha’ in them. I’ll give you an example: A person will have to pay … if we don’t find a polyp. In other plans, if we find a polyp, then it wasn’t screening, then it was to take care of the polyp, and therefore (the insurance company) won’t pay because it’s not screening. It’s a Catch-22. And then we get yelled at because we coded it wrong.

“If we had regulations that made sense, that were applicable in a normal day… if Congress wants to fine tune it, I think that’s admirable. That is something that makes sense to me. But to say we’re going to repeal it, I think that’s misguided.

“There are many things in the legislation I like; there are many things that I dislike. But all in all, we can work with it. But the most scary words are ‘the secretary shall promulgate regulations.’ That’s what scares the living daylights out of us.

“My personal goal is that everybody has access to health care.”

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