Homer Tribune: Murkowski explains healthcare views

Efforts to shape the Patient Protection and Affordable Care Act, the name of the new healthcare plan under debate in Congress, continue with hundreds of amendments. Eighty six of those were written by Alaska Sen. Lisa Murkowski.

Murkowski's amendments were to address the following: a Senate Health, Education, Labor and Pensions Committee healthcare bill to ensure that Alaska Natives would be able to participate in the healthcare grant programs included in the HELP bill; that Medicare patients could get private health insurance without sacrificing their Social Security benefits; and that physicians' assistants, vital healthcare providers in Alaska, would be eligible for participation in "medical home" demonstration programs.

Another Murkowski amendment wants to ensure patients receive doctor recommendations for preventive health services and that provisions excluding abortion would not become a "required benefit under preventive services."

"My amendment addresses the concern that the government will make coverage determinations for healthcare decisions," Murkowski said. She wants to "keep doctors in" and government out.

As currently written, a U.S. Preventive Services Task Force would determine what is considered preventable care, such as mammograms. Murkowski's amendment would delete this provision from the bill now under discussion.

The most recent proposed amendment deals with small construction firms who employ five people or less. Murkowski believes the bill would unfairly target the small company with mandates for insuring employees. That amendment is now being discussed in the U.S. Senate.

In a question and answer session with the Homer Tribune, Murkowski outlines her concerns as they would relate to a small American town like Homer.

Homer Tribune: For a small business, like say an East End grocery store that employs about 10 people, how would this work?

Murkowski: Under the Senate bill, only businesses with 50 or more workers would be subject to the employer mandate to offer healthcare to its employees. However, a provision was slipped into the healthcare bill that would make small businesses within the construction industry subject to the employer mandate if they have only five or more employees. Failure to comply with the mandate would result in financial penalties of $750 per employee, costing more than $37,000 for a company with 50 employees.
If you work for an employer with less than 50 employees and your employer doesn't provide health insurance, under this legislation you would be required to purchase healthcare or pay a financial penalty of either $750 or two percent of your taxable income.

• If the employee's income is above $54,120 for an individual, then the worker could be expected to pay between 12 percent and 15 percent of his or her income on health insurance. Which, according to Mark Foster, an Alaska healthcare consultant, suggests a net increase on the order of $1,160 a year for single coverage and $2,950 for family coverage in Alaska in 2016.

• If the employee's income is between $16,732 and $54,120, then he or she would be eligible to receive subsidies for the purchase of health insurance through a health insurance exchange. The amount of the subsidy would be based on income. However, even after taking into account the subsidies, the premiums and average cost sharing that the employee would be forced to pick up would amount to roughly 12 percent to 15 percent of his or her income. (Source: Non-partisan, Congressional Budget Office).

• If the employee's income is $16,732 or below, then the employee could be eligible to receive Alaska Medicaid. In fact, according to the Centers for Medicare and Medicaid Service's Chief Actuary, most of those who would be newly covered would receive their health benefits through Medicaid. The Institute for Social and Economic Research at the University of Alaska Anchorage goes even further to say that, for seniors and the disabled in Alaska who are on Medicare, this healthcare bill could make things even worse. Expanding Medicaid would actually hurt Medicare seniors and disabled patients by pushing them to the back of the line in getting access to a primary care doctor in Alaska.

If the small business provides health insurance that the federal government considers to be a high-cost "Cadillac Plan" ($8,500 price for an individual plan and $23,000 for a family), then these plans would be subject to a 40 percent excise tax. Foster has estimated that - because Alaska is a high-cost state - 50 percent of health plans in Alaska would be subject to the 40 percent excise tax in 2016. That, compared to 19 percent of the plans in the Lower 48. In fact, the plan administrator for the retirees of the Municipality of Anchorage says this provision will hurt retirees by imposing an additional 40 percent tax on the health benefits.
One of the biggest concerns about this bill is that it fails to bend down the cost curve on healthcare spending. So the employees at East End grocery will likely not see a reduction in their healthcare premiums.

HT: What about borough and city employees?

Murkowski: Again, with regard to the excise tax on high-end health plans, if the cost of the borough/school district employees' health benefits exceed the threshold requirements ($8,500/individual, $23,000/family) then the benefits would be subject to the 40 percent excise tax.

We know that Kenai Peninsula Borough employees and teachers who currently have individual healthcare plans will be subject to the 40 percent tax penalty included in the Senate-passed healthcare bill. While family plans currently don't meet the threshold requirement for the 40 percent excise tax, annual healthcare inflation of 6 percent shows it is likely that the KPB family health plans will be well within the range of the 40 percent excise tax threshold when the high cost state trigger expires in 2016.

HT: Currently in Homer, for "affordable" healthcare there is the sliding scale clinic, the SVT Medical Center, which gained stimulus funding recently due no doubt to your efforts as well. This means a doctor's visit costs $20 for some people; others might pay $75, etc. How will the new healthcare plan compare in terms of what that individual might have to pay in the future?

Murkowski: SVT Medical Center could see additional funding for Community Health Centers; however there will also be a cut of nearly a half-trillion dollars from Medicare services which could harm patient access to primary care doctors.

Cuts to Medicare will restrict access to primary care doctors because fewer private doctors will be able to continue seeing Medicare patients. This in turn will result in a shift in care from private doctors to safety net providers such as critical access hospitals and community health centers for Medicare patients and therefore, longer lines and greater waits as more patients turn to the clinic for care.

South Peninsula Hospital and SVT have played a key role in providing quality healthcare in both primary care and emergency care services. However, as the Senate bill will cut nearly a half-trillion dollars from services to Medicare patients, there is a legitimate concern that the overall funding of federal health care programs such as the Indian Health Services, Medicare, Medicaid, Veterans Health and Safety Net Providers like Community Health Centers and Critical Access Hospitals could be in peril in future years.

HT: The public is being assured that people who already have satisfactory health insurance arrangements can keep their same policies. Would you elaborate on this, as it seems to be one of the points that draws skepticism?

Murkowski: According to the CMS Chief Actuary, the number of people with employer sponsored coverage would drop by about 17 million due in part to small businesses dropping coverage, companies with low average salaries ending their plans, and the two million people with employer coverage who would go to Medicaid. This would affect the ability of individuals and families to keep the same insurance coverage they currently have in place.

HT: How will it impact Alaska Native healthcare? Some people see the system as that Native people receive "free" healthcare. In reality, for a second opinion or a hospital not authorized by the IHS, Native people do pay for the services they receive.

Murkowski: The Alaska Native Health System does a remarkable job of providing world class healthcare to Alaska's Native people in spite of chronic funding challenges.
When a particular type of care is not available in the Alaska Native health system, Native people can tap a Contract Health Services account which is used to purchase care from non-Indian health facilities. Historically, Contract Health Services accounts have been underfunded. It is likely that President Obama would propose across the board reductions in federal discretionary spending to bring the deficit under control. History suggests that Indian healthcare accounts are not immune from across the board cuts in federal discretionary spending. So enactment of the national healthcare legislation could make it more difficult for the Indian healthcare delivery system to continue its good work. Appropriations to the Indian Health Service currently fund about two-thirds of the healthcare needs of America's first people. The Indian Health Service cannot afford further cuts.

HT: What is the schedule for when we might see this bill passed?

Murkowski: President Obama has indicated he wants to have a healthcare bill passed before the State of the Union, presumably before the end of February. While we still don't know when the president will give his State of the Union, we know that there is an intense push by the White House to pass this healthcare bill in order to move on to the jobs crisis and energy legislation.

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Source: By Naomi Klouda. Originally published in the Homer Tribune on January 20, 2010