Marguerite Salazar listens to a Valley resident during Saturday’s health care forum.
Courier photo by Sylvia Lobato
Special to the Courier
ALAMOSA — The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “Obamacare,” has been the topic of information and misinformation since it was signed into law in 2010, but a forum at Adams State University Saturday cleared up a number of questions.
“Talk Straight With Adams State” drew a good crowd and a panel of experts, who worked to advise their listeners about PPACA.
Educational programs will begin in June of this year, while preparations will begin in October, then the PPACA will go into full effect in January 2014.
Although the state of Colorado is at least two years ahead of much of the nation in terms of health care, there is still confusion, which was addressed in detail.
Colorado has begun its own health care reform, giving it a leg up as the nation moves toward full implementation of the PPACA.
Facilitated by Adams State University Community Partnerships, the forum and panel discussion revolved around how the Act will affect citizens of the San Luis Valley.
Saturday’s panel included Tom Deegan, a registered nurse and author of “Healthcare: A View from the Trenches;” Dr. Ned Calonge, president and CEO of the Colorado Trust; Reginaldo Garcia, PhD. UCD, Rocky Mt. Prevention Research Center; Russ Johnson, CEO of the SLV Regional Medical Center; Gigi Darricades, CEO of Valley-Wide Health Systems(VWHS); Marguerite Salazar, regional director for the U.S. Dept. of Health and Human Services (HHS); and Armando Valdez, ASU professor of health care administration.
Moderating the discussion, Valdez reminded the audience that PPACA is the law of the land and will go into full effect in 2014, though some provisions are currently being administered.
Following a welcome by ASU President David Svaldi, who exhibited his newly obtained Medicare card, Salazar began her presentation with a quote from Dr. Martin Luther King, Jr., about the “severe urgency of now,” which drives the transformation of health care.
She said the mother of her 35-year-old nephew had to go to the emergency room for prenatal care because the available doctors were not accepting any new patients. She was insured, but it still didn’t help.
The concern grew that people were unable to buy adequate insurance and Salazar saw it even more when she began a 20-year career as CEO of Valley-Wide Health Systems (VWHS).
Addressing the growing need, VWHS began opening clinics around the Valley, including the Convenient Community Care Clinic in Alamosa and the Kennedy Clinic in Monte Vista.
When she was offered the position with the HHS, she said it fit her goals and ideals, with the region’s expanded coverage and ability to help effect the changes that were to come.
She said the changes thus far have actually brought a drop in Medicaid costs, but the biggest winners are senior citizens and children, while there are substantial benefits to the uninsured.
Among the changes on tap are a provision that no one can be denied coverage due to pre-existing conditions and the requirement that insurance companies abide by the 80-20 rule and spend 80 cents of every dollar on health care.
Salazar said the people of Colorado are very secure, since theirs is one of few states to effect Medicaid expansion and create its own insurance exchange.
While the medical care maze may seem daunting, there will be navigators to help residents through, she pointed out.
Deegan said the nurses in the audience would probably agree that one of the problems is “dysfunctional hospitals,” which demand too much paperwork from an already overburdened staff. He noted that emergency room costs are rising due to requirements for unnecessary testing.
Calonge said the Colorado Trust is a private foundation that funds much of Colorado’s health care and will continue to invest its profits and then give them away, to offer access to health care for all Coloradans.
“We are trying to turn a new page, focusing on health equity,” he said. “There is a remarkable lack of diversity in health care.”
“The ACA is a good bill, not a great bill,” he continued. “It has its faults and will still have to have a lot of support in implementation.”
Garcia said prevention and public health improvement are also parts of the act. While many people claim the length of the act is a problem, he noted that the PPACA is 974 pages long and that is still shorter than the latest Harry Potter book.
He said studies are in progress aimed at promoting healthy living from birth well into adulthood, creating healthy habits.
These include nutrition, physical activity, sexual activity and substance abuse, and the work is targeting students, staff and parents in an effort to make changes at the school level.
In the community, Darricades said, the act ties in wonderfully with the VWHS mission, helping staff to work with the insured, underinsured, uninsured and migrant populations.
That work won’t change under the PPACA, she said, since a great number of Valley residents already qualify for Medicaid and the built-in tax credits will assist the rest in purchasing insurance.
“There will always be challenges in the area of insurance premiums,” she noted.
VWHS is preparing for more patients, she said, and the Medicaid expansion will be a great benefit.
One problem is the movement of providers and the need to recruit professionals into rural medicine and keep them here.
“We are looking at a change in the style of medicine,” she said. “We are working hard to retain physicians so patients will have the same provider.”
The new electronic access to patient records is also a big help, Darricades said.
Adding to that, Johnson said SLVRMC sees a three-pronged component to PPACA: Insurance reform, increased access and innovation.
“Insured people are healthier,” Johnson noted. “Access is important.”
“We are incredibly lucky in our Valley to have agencies that serve the underinsured (and uninsured),” he said. For them, it is incredibly difficult to get in to see a specialist.”
With the PPACA, he said, “hundreds of thousands or people who are not getting health care will be.”
Innovation is the heart of the PPACA, he said, since “our health care system isn’t affordable” and the act creates a huge incentive for it in health care.
“We are learning how to engage patients and families differently.”
Deegan added, “Learned helplessness has been a part of our system.”
The purchase of insurance will be required, Salazar pointed out, but there will be incentives to help the process along. Small businesses won’t be mandated to buy insurance for their employees, but tax credits will make it possible.
“It’s important to recognize the cost savings in the law,” she added.
The federal option won’t exist in Colorado, so the state has stepped in. Here, the cost will depend on what health plan the individual chooses to buy. There will be a sliding scale, and the prevention aspects of PPACA will bring down the costs of health care, Johnson pointed out.
“There are provisions for very low income people and those who simply can’t afford it,” Salazar said, and some groups have formed co-operatives so they can bargain for lower premiums and commonly buy insurance. Co-ops are public options.
“We must become more discerning consumers,” Johnson added.
Garcia said, “prevention is at the beginning of this pathway.”
“Seeking better care of oneself will lower the number of high cost illnesses.”
Darricades said the act’s coverage of preventive services will be beneficial, though the cost effectiveness won’t be seen for a while More illnesses are due to people not having care, she noted.
Salazar said a huge list of preventive services is available for no out-of-pocket costs.
Before, many of these were not covered by Medicare unless an illness had already been diagnosed.
While they are free, the services will still need to be provided by a physician, who will then treat whatever problems are found.
The goal, they all agreed, is a healthier population.