As Teller County residents toss around invectives or praise about the Affordable Care Act, Terry Buckner, chief executive officer of Pikes Peak Regional Hospital and Surgery Center, has actually read the 2,000-plus page bill.
“I used to have it sitting on my desk if anybody wanted a copy of it,” said Buckner, who held the same position at Eastern Oklahoma Medical Center.
With the Supreme Court decision in June approving the mandate that all citizens buy health insurance, the ruling left open the option for states to expand Medicaid. “That puts us in an interesting situation, because we've got about eight redneck states that hate Obama with a passion,” Buckner said.
Oklahoma, Buckner's native state, is one of the eight to reject the benefit of the federal government covering 100 percent of the costs for the first two years for new enrollees. “Gov. (Mary) Fallin says she doesn't want to increase the federal deficit; but what about the deduction for interest on home mortgages? Same concept. The expansion is out there and Oklahoma should take advantage of it,” he said. “This is one of the worst public policies I've seen. If you live in Oklahoma you pay your federal tax anyway, part of which goes for health care for the working poor.”
Speaking to the urban legend that views “Obamacare” as a gift to the lazy, the non-productive, Buckner reacts. “This expansion is for the guy trying to support a family on $30,000 a year and there's no coverage anywhere. That's what this is for, trying to help people get insurance,” he said. “Oh, I get mad over what people say about it.”
While all hospitals are required to treat emergency-room patients, for the uncompensated care hospitals receive additional payments through Medicare. “They call it `disproportionate-share payment' which goes on top of the Medicare rates,” Buckner said. “Every check we get from Medicare is shortened, and it's not a whole lot, goes into the fund. People don't realize that hospitals have been paying into a fund for two years to help start funding the `Obamacare' stuff.”
In Oklahoma, however, hospitals lose their disproportionate share. “And the poor people who are supposed to get the care don't get it. So the state gets hit twice. I could understand it, wouldn't agree with it, if their federal taxes were to go down, but they pay the exact same tax and don't get the benefit,” he said. “I'm not saying I'm a proponent of Obamacare - but it's the law of the land right now so we need to maximize the states' benefit from it.”
With mental-health issues on the public mind these days, the ACA includes expanded coverage. “Right now there is very little government money for mental health,” he said. “With `Obamacare,' health insurance companies have to cover mental health.”
In Oklahoma, only a small portion of mental-health expenses come from the federal government. “Oklahoma had to fund the rest of it. Now, since the state is not going to expand Medicaid, people are going to pay the tax anyway. The state would have saved millions because they wouldn't have to foot the bill for mental-health services,” Buckner said. “So did Texas, Louisiana. It's just dumb. Bad policy. I'm glad that Colorado decided to expand.”
Disgusted with presidential candidates who vowed to get rid of portions of the new health-care law their first day in office, Buckner suggested a reality check. “The way I take `Obamacare' is that it needs to be all or nothing; don't start trying to chip off pieces of it. Either ban the whole damn thing and start over or leave it alone and let it work,” he said. There are funding mechanisms out there that, if you start chipping away from it, you lose funding for taking care of the poor. Just like Oklahoma has done.”
The Affordable Care Act goes into effect in 2014
“We are going through what could be the most profound change in the delivery of health care since Medicare,” said Terry Buckner, the new chief executive officer of Pikes Peak Hospital and Surgery Center. “How that's going to work nobody really knows.”
However, in the second phase of the Affordable Care Act, the potential to reduce the overall expenditures for health care is actually there once you get insurance for everybody, Buckner added.
Under the new law, states are required to implement health-care exchanges which, in Buckner's view, will function according to the capitalistic system. “Markets will react to the fact that more Americans will now have health insurance,” he said. “With health-care exchanges, available for consumers via the computer, companies that offer the lowest prices will, in general, reap the benefits. The markets will even out.”
Along with the exchanges, physicians and hospitals will be required to maintain electronic records that funnel up to a super computer, a health-information network, the technology funded, in part, by the stimulus package. “Push a magic button and health records appear,” Buckner said.
Another provision is the implementation of the “Medical Home,” where the primary care doctor manages all health care for patient. “It's the most fascinating time in health care,” he said.