Beam: Health care future uncertain

By By Jim Beam / American Press

No one knows exactly how the nation’s

health care system is going to change come Jan. 1, 2014, but Americans

could be in for

major surprises. Many of the provisions of the federal Affordable

Care Act, popularly known as Obamacare, go into effect then,

and we are getting some early hints about what is to come.

Obamacare isn’t the major reason, but

it obviously played a part in the emergence of concierge medicine. We

usually think

of a concierge as a hotel employee who assists guests by arranging

tours and making other reservations. In the medical field,

patients get special treatment from concierge doctors.

Patients who can afford to pay the

annual fees are turning to concierge medicine for their health care

needs. The Advocate

last month described how the system works. Those annual fees range

from $200 a year to $1,500 or more. Concierge doctors limit

their patient loads from 400 to 600 people, give them better

service like same-day and longer appointments and 24/7 access

to their doctors.

The newspaper said a number of reasons

have been cited for the growth of concierge medicine. Many physicians

believe the existing

health care system is dysfunctional. They complain about constant

reductions in the government payments they receive from

Medicaid, the federal-state health care system for the poor, and

Medicare, the government program for older Americans. And

they don’t like increasing government interference in their daily


One controversial Obamacare requirement has already been postponed for a year. It requires medium and large companies to provide

health care coverage for their workers or face fines. The change means those companies have until Jan. 1, 2015, to set up

health care for their workers.

Although the business community welcomed the delay, others point out the change won’t take place until after the 2014 mid-term

congressional elections. Obamacare is so unpopular the new requirement is seen as troubling for Democrats seeking election

in both the U.S. House and Senate.

House Speaker John Boehner, R-Ohio,

said, “The president’s health care law is already raising costs and

cutting jobs. This

announcement (of a year’s delay) means even the Obama

administration knows the ‘train wreck’ will only get worse. This is

a clear acknowledgement that the law is unworkable, and it

underscores the need to repeal the law and replace it with effective,

patient-centered reforms.”

On another front, some companies report their health care premiums for employees have already gone up as much as 15 percent

because of Obamacare. And they expect a similar rate increase or one even higher next year.

It should come as no surprise, then, that Politico, a political journalism organization, reported last week that “Obamacare

is more unpopular than ever...”

An NBC News/Wall Street Journal poll showed only 37 percent of those surveyed think Obamacare is a good idea. A larger 49

percent say the act is a bad idea.

Insurance exchanges are one of the

sources the uninsured will look to for help. Most are being set up by

the federal government

as places where people can buy health insurance with the help of

federal subsidies. No one at this stage is really sure how

that system will work.

The news also isn’t good for those who are disabled, according to The Advocate. They will lose their Medicaid eligibility

after Jan. 1 and have to count on other sources for their health care needs.

The 9,800 Louisiana residents on the Disability Medicaid Program will have to count on the U.S. Social Security Administration

to determine whether they are eligible for Supplemental Security Income benefits. The SSI eligibility process is terribly

slow in determining whether people qualify.

The uncertainties and unknowns in Obamacare are unnerving to those who have adequate health care and to those who don’t. Neither

group knows exactly what the new year will bring.

Nevertheless, 38 percent of those

polled by NBC News and the Wall Street Journal said they believe the law

makes them worse

off. That is the highest figure the survey has found since

President Obama signed the law. Only 19 percent said it would make

them better off, and 39 percent said it wouldn’t make any


Americans without health insurance have

a more favorable view of the law than those who have coverage. That is

because they

have everything to gain and nothing to lose. However, 2 in 3 of

them may lose out because their states have opted out of an

expanded Medicaid program. Louisiana is one of those states, and

up to 400,000 of its citizens won’t get the Medicaid coverage

that currently pays doctors, hospitals and others who provide

health care to the 1.2 million state residents already on its


National Journal, a political news magazine in the nation’s capital, got to the bottom line. It said the Obama administration

can’t win on health care. Maybe not, but most of the new law’s provisions are still going into effect Jan. 1. And at this

point, that looks like a scary proposition.

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Jim Beam, the retired editor of the American Press, has covered people and politics for more than five decades. Contact him at 494-4025 or