Program gives insight to Affordable Care Act

Published Apr 22, 2013 at 4:51 pm (Updated Apr 22, 2013 at 4:51 pm)

A group of more than 50 people spent the morning of April 21 in the community room of the Peters Township Public Library learning about the federal Affordable Care Act, set to be implemented Jan 1.

The multi-page act is designed to ensure everyone in the United States receives health care insurance regardless of the level of employment.

Beginning Jan. 1, every employer with 50 or more full-time equivalent employees must provide employees with health insurance or the employees must be offered $400 to purchase insurance in the private sector.

The more that is known about the act, the more one realizes how little is actually known.

“It is difficult to explaining this legislation in 20 minutes,” said Patricia Raffaele, a Peters Township native who is vice president, advocacy and communications with the Hospital Council of Western Pennsylvania. She was one of three speakers for the program. The others were Jerry Bonenberger, senior account executive at BABB, Inc., and state Sen. Matt Smith, D-Mt. Lebanon, who represents the 37th Senatorial District, of which Peters Township is the only municipality included in Washington County.

Raffaele said the act is actually two pieces of legislation. Estimates are that 42 to 60 million Americans are uninsured. That translates to one out of five under the age of 65 who do not have health insurance. The pending legislation will cover about 32 million of those uninsured, Raffaele said. Many others are underinsured and carry high deductibles. Health costs are going up at an alarming rate with an estimated $14,000 annually to cover the cost of a family of four. Hospitals must treat patients regardless of whether the patient has insufficient health care coverage, or has no coverage at all. Someone must pay the costs and that usually falls to the individual hospitals.

Raffaele said by mandating health care coverage, hospitals and long-term nursing centers will realize less uninsured health costs.

“The emphasis is on the quality of care and we want the biggest bang for the buck,” Raffaele said.

The legislation also calls for children up to age 26 to be covered. There will be no life-time limits and there will be a push for electronic record keeping. The latter, Raffaele said, will place a burden on small, independent physician offices.

Bonenberger said the act will impact everyone.

“The cost of health care is very expensive and is going up every year,” Bonenberger said. “There is a lot of confusion in this act.”

Babb Inc. has been in the insurance broker industry since 1929.

Bonenberger said only 16 percent of Pennsylvanians get an annual physical.

“Imagine if only 16 percent get their car inspected each year. We’d be Ohio,” he said to laughter.

There are benefits to the act, such as no penalties for pre-existing conditions, and everyone will have access to affordable health care. On the down side, everyone is going to have to pay, he said.

On the positive side, the act will promote preventative care and wellness.

Unfortunately, if an employer does not provide health care or pay for the employee to choose their own, the government will impose taxes and penalties.

By Jan. 1, a vast majority of Americans must have or buy coverage. There are a few exemptions, like inmates in prison, he said to additional laughter.

One of the biggest challenges before the act is implemented is to educate those who decide to seek their own insurance, mainly through agencies known as exchanges.

That’s where the state plays a role, according to Smith. Exchanges vary from state to state. Smith, a Democrat, was critical of Republican Gov. Tom Corbett’s decision to default from the state exchanges to the federal government.

Developing state exchanges is “a more prudent approach,” Smith said.

Currently, as for those uninsured or underinsured, Smith said the hospitals will “eat that cost,” which is about $1 billion annually.

Although Smith said he disagrees with Corbett on the exchange issues, he feels implementing the act and resolving ensuing problems should be a bi-partisan issue.

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