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Expert: Health Insurance Mandate Needed – Only 1-Percent will Pay Penalty


Thursday, July 12, 2012   

RICHMOND, Va. - The U.S. House of Representatives voted on Wednesday to repeal the health care reform law, 244 to 185. Not just politicians are divided - some polls indicate many voters are still uncertain about the law, especially when it comes to the individual mandate.

Edwin Park, an expert on health policy with the Center on Budget & Policy Priorities, says the individual mandate is an important step in terms of reining in health care costs - primarily because it will make the health insurance pool bigger, with a balance of sick and healthy people.

"Right now, people who are uninsured, if they get sick, end up going to a hospital or an emergency room. Everyone's currently paying for that uncompensated care, through higher premiums."

Park says people will not be required to purchase one particular type of insurance. The mandate can be met in a variety of ways, such as through Medicare, Medicaid or new health insurance exchanges or private insurance. According to the Congressional Budget Office (CBO), only about 1 percent of the population will pay a penalty for not purchasing some sort of coverage, because nearly everyone will be covered under the Affordable Care Act.

Ray Scher, a retired nurse with Anthem in Virginia, says once the Affordable Care Act is fully implemented, the next focus can be to phase out the current "Fee for Service" structure, which means doctors are paid by insurance companies for numbers of visits and for ordering tests. He calls this system wasteful and describes a new pilot plan.

"Under this new plan, providers - a hospital chain or a doctor's practice - will receive a basic amount of money through the patient's insurance. Then they have to provide all the coverage that patient needs for the year when they receive that sum. There won't be this incentive to test, test, test...see people, see people, see people."

Scher says prevention is one of the biggest components of keeping health care costs down. According to the U.S. Department of Health & Human Services, more than 470,000 people in Virginia received at least one preventive care service during the first half of 2012 at no cost to themselves, thanks to the health care law.

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