Health care law expert sees value of reforms

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By Paul Janczewski

Legal News

The Affordable Care Act can be described in 25 words or less, but to fully understand it might require reading 250 pages. Or more.

"Actually, the link to the statute itself comes up to 985 pages," said David Rogers. "So, it's a lot of reading."

Rogers knows of what he speaks. A shareholder and founder of the Farmington Hills law firm of Rogers Mantese & Associates, Rogers specializes on representing health care providers and associated professionals in all legal health care related matters.

The Patient Protection and Affordable Care Act is known by several names, some flattering, and at least one, intended as a knock on President Barack Obama, whose efforts made it the law of the land in 2010.

No matter what it's called, the Affordable Care Act will play out over the course of the next decade as portions of it ease into effect, according to Rogers. But the complexities of it will make solving a Rubik's Cube look like child's play. Who really understands the entirety of it?

"Plenty of people in the health care industry are still in the dark, too," Rogers said.

But he is a believer that the way we handled "all the moving parts" of health care needed a change.

"It's been something people have talked about for many years - how do we provide health care for those who can't afford it," he said.

Before the act, he said, we used the most expensive method of providing services. If people needed care, and had no coverage, they went to a tax-exempt, nonprofit hospital that was required to take in everyone regardless of ability to pay. That method, of course, did not spread the risk around, according to Rogers.

The act requires everyone to become insured at the risk of financial penalty. And therein lies the rub to many who oppose the act. Rogers said other countries have some form of health care, "but there's not a country I could point to and say that's a model we should follow."

Some portions of the act went into effect immediately, while others have deadlines in 2013 and beyond. It will affect insurance premiums, doctors and physician groups, hospitals, insurance companies, and the entire array of fields and people associated with every aspect of health care. It is the most significant and comprehensive overhaul of America's health care system since 1965, when Medicare and Medicaid came into existence.

And anything that aims to decrease the number of uninsured people while reducing the overall costs of health care will take time, money, and a good deal of compromise, said Rogers.

One factor that already has caused some concern is the health insurance exchanges. While more than a dozen states have established their own, other states are letting the federal government determine those, Michigan being one. Rogers said that part of the act will address the cost of premiums and the availability of coverage.

"It's not like we won't have a health insurance exchange, it'll be one that's a cookie-cutter kind that the federal government designs because Michigan didn't design its own," he said. "And it seems to me we should be designing our own, and not looking to Washington."

In the future, he believes Michigan will adopt its own health insurance exchange, and perhaps other states will follow suit.

"For a lot of issues, states will know themselves better than the federal government does, and no matter what state it is, you're probably better off designing one that fits you," Rogers said.

Down the road, the act will impact doctors, consumers, health care professionals, insurance companies, health care facilities, hospitals, nursing facilities and businesses, all of which will be required to make some choices.

"Not only are they affected individually, but their inter-relationships are affected greatly," he said.

With health care costs rising, these entities will develop new ways of grouping and working together to provide products that will resemble one-stop shopping centers for a vast array of health services, Rogers said.

"Now those are like skeletons, with no meat on it, but over time, it will develop," he said. "But you'll see providers all working together to provide the whole spectrum of services."

He said that is taking shape now in the form of an "organized system of care" or OSC. Those have been in use for several years and are designed to encourage primary care providers to share information, thereby avoiding duplication of services such as X-rays and MRIs.

While the act may sound good in theory, can it really work?

"Sure," Rogers said. "It will take time, and there will be some bumps in the road, like with anything else. It's not easy, it's complicated, it's expensive, but I'm convinced it can work. Uninsured people would be able to get insurance, in some cases with help from the government, and I think that's a very important thing," Rogers said.

Rogers said it is a story to-be-continued, harkening back to all the naysayers who decried the creation of Medicare and Medicaid.

"Some thought it was a disaster and would ruin the country and health care. But just the opposite occurred. It's become the pace setter, the best organized at carrying out its job, much more so than private insurance," Rogers said. "Some may not think that way, but that's what I've seen."

Published: Mon, Feb 4, 2013

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