November 12, 2013

Pediatrician: Obamacare an improvement, but doesn’t fix all

Rachel Brown
rachelbrown@daltoncitizen.com

— Obamacare isn’t perfect, Dalton pediatrician Jeffeory H. White told a group gathered to hear about changes in health care laws Monday night, but it’s a step in the right direction.

“I live the Affordable Care Act,” he said. “That’s been my life since 1981.”

Speaking at the Mack Gaston Community Center, White said that when he came to Dalton more than three decades ago, advances in health care reform that many take for granted today didn’t exist. For several years, he said, he admitted more patients to Hamilton Medical Center than any other doctor, and that was often in response to children’s illnesses going untreated for so long that they eventually became serious enough to require hospitalization. Not until some government-enforced reforms several years ago that resulted in well-child doctor visits being covered by insurance did the number of children admitted to the hospital begin to drop, he said.

White said Obamacare likewise represents progress. Some of the patients who receive the worst care are those on private insurance, he said, since they refuse preventative services that could help them because they’re concerned about the co-pays for those services. The flip side of the private insurance equation is that it can also bring better care to a community because it’s often easier for doctors to accept private insurance — less red tape and hassle than filing for documentation for certain government-provided plans, White said.

One of the defining features of the Affordable Care Act is its provisions for people to buy insurance on health care exchanges, at HealthCare.gov, and, in many cases, receive subsidies for their premiums. That provision, White said, could get more people on private insurance, thus possibly drawing more doctors to Dalton.

Yet there are still some people who won’t be covered. Attorney John Minor said that under certain incomes — it varies depending on the number of people in a household — people living in poverty can be covered by Medicaid. Those who make 100 to 400 percent of federal poverty guidelines are likewise eligible for subsidized health insurance under the reforms. In between, however, are some of the nation’s poorest people, and while they won’t be penalized for not buying insurance, they also might not be able to afford it, even with government subsidies.

That’s at least partly because Georgia decided not to expand Medicaid coverage that would have provided for those people, Minor said. State Rep. Bruce Broadrick, R-Dalton, said after the meeting that Gov. Nathan Deal decided against the expansion because Georgia didn’t have the money to pay for adding an estimated 600,000 to 700,000 people to the 1.2 million already on the rolls. Broadrick said lawmakers do plan to look at some Medicaid reforms in the legislative session that begins in January.

Allie Griner, a trained and licensed health care “navigator” for the new law from the University of Georgia Cooperative Extension, said households that would have to pay 8 percent or more of their incomes to purchase health insurance get a waiver and don’t have to pay a penalty. Everyone else must obtain basic insurance somehow, whether through an employer or through a government program, or face escalating penalties.

Those penalties, Minor said, start at $95 per adult up to $285 per family beginning next year and escalate to $695 per adult or $2,085 per family by 2016. Alternatively, those who don’t have insurance could have to pay 1 percent of their income annually beginning in 2014 or up to 2.5 percent in 2016. Non-insurance holders are required to pay whichever formula results in a greater cost.

Griner said individuals have until March 31, 2014, to sign up for insurance without facing a penalty on their income taxes next year. The health care exchange website is still experiencing problems, she said, but officials expect to have many of the issues addressed by the end of the month.

Griner is among several certified health navigators available to help answer questions and show people how to sign up for insurance. She will be at the Community Center every Thursday except Thanksgiving from noon to 5 p.m. starting Nov. 21 and going through at least Dec. 15. She can be reached at (706) 424-3091 or allie723@uga.edu.