A nationally known economist in the fields of health care and aging said Monday that when health exchanges begin offering insurance under the Affordable Care Act next week, she expects some start-up glitches and that some employers will take advantage of the confusion to cut benefits and blame the government.
But the benefits of the new law will outweigh the growing pains, predicted Marilyn Moon, director of the Center on Aging for the American Institutes for Research and a former trustee of the Medicare and Social Security trust funds.
“I think I would say to somebody out there the world will not end on October first,” the day that health exchanges will become available under the ACA, Moon said.
“The sun will come up and people will still get health care,” she said. “And what may change is some people may be able to sign up for insurance that they weren’t able to get.”
Moon, an Augusta native, is in Kansas this week to speak at the annual Sunflower Fair, an event for seniors and caregivers Tuesday at the Bicentennial Center in Salina. About 700 people attend the event each year.
Moon said she does expect some legitimate glitches and setbacks when the health exchange system begins. But it will be hard to tell which of those are actually a result of the ACA and which are businesses taking advantage of the change to push benefit cuts on employees to cut costs.
“Some negative things are going to happen and get blamed on the ACA, and the question is, was it really their fault?” she said. “Is UPS cutting off paying for spouses really because of the ACA or because UPS for a long time has been trying to find a way not to provide as much health care coverage as in the past?
“We’ve been on a long trend for a long time of employers cutting back health benefits, and that’s going to continue,” she said.
The difference is that with the ACA in place, if companies do cut health benefits for their own reasons, employees will have a place to get coverage.
Overall, she said she thinks the ACA will be a benefit for millions of Americans, particularly those who are jobless, self-employed, working for companies that don’t offer health benefits and those who have had pre-existing conditions such as diabetes or cancer that render them essentially uninsurable in the current system.
“As somebody who’s studied health care for a very long time,” Moon said, “I know that giving people access to health insurance helps improve their health, helps the system as a whole because it means there aren’t people needing charity care, delaying getting care, etc.”
Mandating that everyone have insurance spreads the cost and keeps insurers from cherry-picking healthy customers who are less likely to file a claim, she said.
“I just don’t find anything about that all that radical, certainly as compared to when Medicare came in,” she said.
While relatively few people remember, Medicare was extremely controversial when it started, she said, in large part because it forbade racial segregation in hospitals that wanted to be paid under the system.
“Physicians called it socialized medicine and threatened to boycott, until they realized they were going to get paid for care that they used to give for free,” Moon said. “The irony is it came in with a whimper and not a bang.”
Not that Moon doesn’t see problems in the health-care delivery system that need fixing, with or without the ACA.
For example, medical testing.
“We test in the United States so much more than people do in other countries, and there’s not very good evidence that that is terribly effective,” she said.
And while the U.S. boasts some of the most advanced medical technology in the world, providers here fall flat when it comes to the seemingly simple task of sharing those results among care providers, she said.
“There are still hospitals in the United States where if you go in and go to the emergency room and they do a test on you and decide you need to be admitted, they don’t have systems that are good enough to have that test follow you into the hospital even though you’re in the same building, so they redo it,” Moon said.
The problem as she sees it is that different providers buy systems from competing vendors, then need to go to more vendors to get more software so the incompatible systems can share information. Everyone would benefit from less competition and more standardization, she said.
“As an economist, I can tell you that it was drummed into me that competition is good, it lowers costs,” she said. “But that’s when you’re talking about growing tomatoes and potatoes.
“Something as complicated as health care, you’ve got to be a little careful about assuming that competition is always going to lead to lower costs and prices.”