From 'Hallelujah' to 'Sadness,' Health Care Stakeholders React
Ray Suarez gets some reaction on the Supreme Court's ruling from Ron Pollack, founding executive director of Families USA; Karen Ignagni, president of America's Health Insurance Plans; Dr. Donald Palmisano, a physician and an attorney; and Bill McCollum, a former congressman and Florida attorney general.
JUDY WOODRUFF: And now Ray gets some reaction and assessment from those who will deal with the law or had worked to overturn it.
RAY SUAREZ: And, for that, we turn to Ron Pollack, founding executive director of Families USA, a national organization that advocates for affordable health care in the country, Karen Ignagni, president of America's Health Insurance Plans, a lobbying group that works on behalf of the health insurance industry.
Dr. Donald Palmisano, who is both a physician and an attorney, he is a general and vascular surgeon who teaches at Tulane Medical School. And Bill McCollum, a former congressman who, when he was Florida's attorney general, sued the Obama administration over the health care law.
Guests, I would like to start with a quick, distilled thumbnail description of your reaction to this big ruling and complex set of opinions.
RON POLLACK, Executive Director, Families USA: I think this is a hallelujah moment for America's families. It will provide them with peace of mind that they will have health coverage and care when they need it.
In the various ways that Susan and others describe, it will make sure that people no longer are denied health care coverage that they so desperately need.
RAY SUAREZ: Dr. Palmisano?
DR. DONALD PALMISANO, Physician: Well, my reaction was one of sadness.
It's not going to increase access. It's not going to enhance quality and it will increase the costs of medical care.
RAY SUAREZ: Karen Ignagni?
KAREN IGNAGNI, President and CEO, America's Health Insurance Plans: There was significant uncertainty about the market reforms and universal coverage. The court clarified that today, that the link has been established, so we will not repeat the mistakes that were done at the state level.
At the same time, we have to zero in now on the affordability issues which are underlying here that I suspect we will talk about.
JEFFREY BROWN: And, finally, Bill McCollum?
BILL MCCOLLUM, Former Florida Attorney General: Well, I was shocked and disappointed in Chief Justice Roberts' decision to call this a tax, instead of a penalty under the law.
And I think the end result of this is going to be a very negative thing for all of us. Going forward, there are a couple of positive things out of it. Number one, there is big precedent here now to say that the interstate Commerce Clause does not -- is not something that can be applied in the future to require you to buy a product or a service.
That's clear. A majority of the court, including the chief justice, said that. I think, also, there's real precedent being set that in the future we are going to have something to go on when it comes to coercing the states in the Medicaid decision beyond the health care front.
But the health care law itself is complicated. The result I think was sad. And I think that Chief Justice Roberts' argument on the tax is contrived. It was disingenuous. I think those who said he's rewriting instead of interpreting are correct.
But he stretched it. And that's how he came out.
RAY SUAREZ: Karen Ignagni, are we done? Can your members, who are insurers, start working under the new rule book knowing where things are going to be now, next year, the year after?
KAREN IGNAGNI: Well, they're already working. We have been working for a year-and-a-half in terms of taking on the implementation that's required under the legislation.
RAY SUAREZ: But do you have certainty now?
KAREN IGNAGNI: We have certainty about the universal coverage, people being in the pool.
The whole objective here to make sure that this can be economic, can be sustained, and can be an insurance system, rather than a sickness fund, is to have the younger and the healthier people in, which is why, Ray, we have to now -- now that we have that certainty about how the universal coverage provision will work, we have to turn our attention to provisions in the legislation that have not been focused on which will inadvertently increase costs.
And nobody wants that.
So to make this possible for people to actually purchase insurance, it's going to be important to focus on that. But there's time to do that between now and January 1, 2014. We're going to spend a lot of time working with people on both sides of the aisle to array those issues and to offer solutions.
RAY SUAREZ: Bill McCollum, are we done, or are the forces already gathering to continue fighting this battle?
BILL MCCOLLUM: Well, I have often said that, no matter how the outcome of this lawsuit, the debate over health care reform was just beginning with the decision. And I think that's true.
First of all, there will be a big political debate this fall. And the presidential race will have a high-profile part of it focused on this, as will be the question of controlling Congress, without a new president and without a Republican majority in the House and Senate both, there are not going to be any significant changes in this law.
Now, secondly, I think that in the next couple years as the 2014 date comes and goes, there are going to be more warts that show up. The financing of all of this is very complicated. And I don't think it's going to work. And I think Congress is going to find that the individual mandate, the Medicaid provisions, all the financing system in here simply won't work, and they're going to have to go back and readdress portions of this.
So that's how I see it going forward. Plus, there will be some other court challenges on other parts of this law that the states don't bring, but probably businesses do.
RAY SUAREZ: Dr. Palmisano, at the heart of the Affordable Care Act are the president's two main stated goals: insuring the uninsured and pushing down the rapid rise in health care costs.
Now that we know, we have the outlines of now the system, what it is, are either of those ambitions going to be achieved?
DR. DONALD PALMISANO: I don't think they will be achieved.
For instance, putting more people on Medicaid -- Medicaid's a failed system. We ought to put Congress on Medicaid for about two weeks, and Medicaid would get fixed. What we need to do, the people on Medicaid need to be on something like the Federal Employees Health Benefits program where they have an array of choices and they can pick and choose the company that they want.
We should allow more of health savings accounts. We should fix the broken medical liability system. We should allow people to buy across state lines, so no health insurer gets too much monopsony power, too much concentrated power. Those are the things that will work.
The broken liability system, 92 percent of the cases that go to trial, the physician wins, and 82 percent of the cases are won -- are closed with no payment when you look at all these cases, and the statistics repeat themselves. The contingency fee is a big pusher for that.
And so we need to -- those add billions of dollars in extra tests because physicians are afraid.
RAY SUAREZ: Ron Pollack, same question. If the Affordable Care Act really wanted to do two things, cover the uninsured, lower cost increases, is it going to do those things?
RON POLLACK: Well, first, with respect to coverage, this is going to expand coverage for tens of millions of people.
Today, we have 50 million people in the country who are uninsured. That's one out of six people in the population. That's more than the aggregate population of half the states in the country, the least populous states in the country.
This is going to expand coverage for tens of millions of people. It does so in two ways. One, it provides subsidies for middle-class and moderate-income people and families, so that they can better afford health care coverage. And even though the Medicaid provision was changed somewhat, there is going to be a huge expansion in Medicaid as well.
And I disagree with my friend Don. I think the Medicaid program is highly satisfactory for the people on the program. It provides terrific service. So I think the coverage aspect of this is going to happen and will work.
Now, with respect to cost, we have a lot of work to do, but one thing I think that is very important, we know that the extra costs that people bear because so many people are uninsured, because these costs ultimately get passed on to people who have insurance, averaged a few years ago at more than $1,000 per family coverage just to pay for the uncompensated care of the uninsured.
When we cover these additional people who used to be uninsured, that will bring the pressure down in terms of premiums.
RAY SUAREZ: Karen, did the pieces of this law depend on each other to make all the numbers work? And once you take that Medicaid piece of it out of there, and the state mandates out of there, do the numbers still add up?
KAREN IGNAGNI: Well, I think there are two separate questions. One is the Medicaid piece.
We're obviously going to have to think about the safety net. To the extent states don't go forward with Medicaid expansion, what happens to individuals who would be in that category who would fall between the cracks? So there is going to have to be a conversation about that, number one.
Number two, in terms of how Congress constructed the legislation, round about the summer of 2009, the health insurance discussion really shrunk from health reform to health insurance reform. And I think that, in an underlying way, has created an issue with respect to cost containment that we really need to zero in on.
I'm going to give you an example. There's a provision in the legislation because revenue was necessary that taxes individuals purchasing coverage, small businesses that purchase coverage. In the end, that's going to be for a small business person a 3 percent additional hit. Nobody wants that. That's moving in the wrong direction.
There are other provisions in the legislation, unintentional, but move in the wrong direction. So I think now, with this clarity with respect to what happens with respect to constitutionality of the mandate, it's time to go back to those underlying provisions and say, will they contain costs? Do we have unintended consequences? What will they be and how do we address it?
There's 18 months, and I think that's what people need to do, roll up their sleeves and talk about that in -- across the isle on both sides.
RAY SUAREZ: Bill McCollum, you were one of the early leaders against the fight of the Affordable Care Act. Now that the court has ruled on the constitutionality of the new Medicaid rules, do you see that opposition continuing?
Will the 25 other states, along with your home, Florida, opt out now that the court has given them the option of doing that?
BILL MCCOLLUM: I think a good number of them will opt out.
Of course, that's a choice they will have to make based upon the lack of flexibility under the new rules. There's not just a money question of what the federal government picks up vs. them on the payments to those who are eligible, but also the question of all of the contrived things that are in there that you have to comply with you don't under current Medicaid.
So there are tremendous problems there. I will add one other thing I think is very important to this. And that is the whole idea behind this Affordable Care Act of the federal government expanding this greatly from top down is going to be a big problem in the future for accessibility.
We already have a doctor shortage in the country. We have a situation where cost-cutting is going to be the name of the game to save the taxpayers money. That is going to be the name of it driven by the federal government under these laws greater than ever before. And as doctors spend less time per patient, less time in trying to diagnose conditions, people are going to get poorer quality care.
We have the greatest quality care in America of anyplace in the world at any time in history. I worry and I think the American people should be that with already existing, looming, big doctor shortage, and this added incentive to cut costs and time being spent with patients, you're going to see big problems in this country with this law, and eventually it is going to get changed for that reason...
RAY SUAREZ: Quickest possible response.
RON POLLACK: You know, with respect to Florida, Florida right now, for example, in its Medicaid program, it only covers parents with family incomes, three-person family of less than $10,000, four-person families less than $12,000. Single adults, childless couples, they get nothing today, even if they are literally penniless.
Because the federal government is providing 100 percent of the funding in the next three years, and it will never go below 90 percent, to help expand coverage through the Medicaid program, I think even states like Florida will opt into this, because it's fiscal malpractice for them to reject it with such generosity from the federal government.
RAY SUAREZ: Quick final comment.
DR. DONALD PALMISANO: Quick final comment.
BILL MCCOLLUM: Let me comment on that.
DR. DONALD PALMISANO: When you say that Medicaid is a good program, it's price-fixed. And they pay the physicians less than the cost of delivering the care.
So talk to Medicaid patients and see how easy it is to find a specialist. The majority of them can't find a specialist in their hour of need. Price-fixing has never worked in the history of the world. You always lose the service or the product.
RAY SUAREZ: I'm sorry. Bill McCollum?
BILL MCCOLLUM: Well, I'm really concerned about what's going to happen to the existing Medicaid program itself.
That's where the hidden costs are, because if more people become enticed to have to join Medicaid because of the fact that the individual mandate is in place and they have to have insurance, the states have to pick up all that cost. And there are a lot of people today who are not currently covered who are currently eligible.
The federal government doesn't pick up 100 percent of those costs in the future under this law. So there are a lot of hidden things that states have got to consider when they look at this, and it is going to be a very difficult thing. It's not as simple as a couple of our guests have said tonight.
RAY SUAREZ: And we're going to have to end it there.
Guests, thank you, all.
KAREN IGNAGNI: Thank you. Thank you.
DR. DONALD PALMISANO: Thank you. Privilege to be with you.