By Dr. Stephen Radinsky

As a retired radiologist, I will never forget the day when I had to tell a woman that her free mammogram, provided through a state initiative, had shown that she had breast cancer. I began telling her about the next steps in diagnosis and treatment and she interrupted me, saying, "You don't understand, I don't have health insurance. I can't afford any of this."

I have spent years wondering what happened to that woman. With the health reform legislation just enacted by Congress, scenarios like this will disappear.

Our healthcare system has been broken for many years. One of the major problems in reforming the system was due to the unwillingness of the insurance companies to compromise. The insurance systems had a virtual monopoly in every state and were unwilling to sell insurance across state lines. Thus, the insurance companies made huge amounts of money. Last year, the CEO of United Healthcare made $1.6 billion in stock options alone. Several years ago, a Blue Cross Blue Shield CEO had a salary and bonus of $337.5 million.

Fortunately, the new health reform laws will vastly improve our healthcare system for everyone by making it fairer. Low-income people will qualify for Medicaid and moderate income people will get help to pay for insurance. An estimated 32 million uninsured Americans will gain health coverage. In Missouri, 495,000 uninsured will gain coverage. More than 1 million Missourians will access coverage through the health exchange. This will make it easier for people to comparison shop for policies. In addition, 516,000 residents will qualify for premium tax credits to purchase health coverage. And free preventive services will be provided to 961,000 seniors. Brand-name drug costs for 171,000 seniors in the Medicare D "doughnut hole" will be halved. Within 10 years, the donut hole will be fully closed.

In Missouri, 79,900 small businesses could receive a small business tax credit to offset premiums. Small businesses eligible for these tax credits employ more than 303,000 workers. In addition to all of these reforms, 559,000 young adults through age 26 will have the right to keep their parents’ insurance. Throughout Missouri, 108 Community Health Centers will receive large increases in funding. And more than 90,000 Missourians with pre-existing conditions will immediately gain access to affordable coverage. As a result of premium and cost sharing credits during the first five years of the exchange, the Missouri economy will benefit from $8.4 billion in new spending. Employers and small businesses will have the ability to create more than 6,000 jobs as a result of stabilizing and reducing healthcare costs. To sum it all up, the new health reform legislation will provide Missourians with health coverage; businesses will be able to give their employees health insurance; and the Missouri economy will be able to grow and create jobs.

Reform legislation includes significant private health insurance reforms to prohibit insurance companies from turning down individuals because of pre-existing conditions, or rescinding policies. The reforms also stop insurance companies from charging higher premiums because of pre-existing conditions, gender, or occupation. The reforms prohibit annual or lifetime limits on coverage and protect consumers with annual out-of- pocket spending caps, after which the insurance company must pay. In addition, the reforms will cap insurance company administrative overhead and profits and require insurers to use premiums to pay for medical care. The reform legislation strengthens oversight of insurance premium rates and increases. It will also allow for sales of insurance across state lines, as long as companies comply with minimum requirements created by states participating in compacts authorizing such sales.

But, if Missouri delays health reform, 128,000 more Missourians will lose health insurance by 2019 and a total of 862,000 Missourians will lack health insurance by 2019. With delay, the average Missourian's family insurance premium will increase by $8,646 by 2019. Missouri's small businesses will pay $3.3 billion more for healthcare premiums by 2018, stifling innovation and job growth.

Health reform will offer peace of mind to those of us who have insurance. Companies will no longer be able to drop us just because we are unlucky enough to get sick. Young adults just starting out can stay on their parents’ plans until they are 26. We will all have the peace of minds of knowing that if we lose our job or open our own business, we can still get insurance for ourselves and our families. Missouri cannot afford to delay health care reform.
Radinsky is a retired radiologist.
Copyright (C) 2010 by the Missouri Forum. 6/10


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