Doctor explains the Supreme Court decision on health care

By Nbc17 Staff

The Supreme Court upheld virtually President Barack Obama's entire historic health care overhaul on Thursday, including the key requirement that nearly every American have health insurance.

But what does the 5-4 decision mean for North Carolinians– and for you? One person with a deep understanding of the issues is Dr. Pam Silberman of the North Carolina Institute of Medicine.

Silberman, in an extensive interview with NBC-17’s Charlotte Huffman, explained the implications of the Supreme Court decision for those who have health care, those who don’t, and even for illegal immigrants.

Here is a summary of that conversation:

Q from NBC-17: What was the impact of Thursday’s decision?

A: Silberman said the Affordable Care Act “tried to accomplish four things”: 1, expand health care insurance and expand coverage for those who had it; 2, invest more in prevention; 3, improve the quality of care; and 4, reign in costs.

“Most of the attention has been on the first part, on the insurance coverage and the individual mandate. What the Supreme Court did today is they upheld that individual mandate. So for most people, beginning in 2014, they are going to be required to have health insurance coverage or they pay a tax, and the tax starts pretty low, at $95 per year per individual…It can go up to $695 a year by 2016.

“Or you buy insurance coverage. And the bill includes a lot of provisions to try to make it easier to buy.”

Q: So what changes for people?

“If you have health insurance, nothing really changes. You’ll continue to get it through your employer. Your benefits will be a little bit better, probably. You’ll get better coverage for preventive services. And if you have a really catastrophic condition or illness they can’t cut you off after you’ve spent a certain amount of money.

“For people who are uninsured, or for whom it is unaffordable, they will create what’s called an exchange. It’s a computer program [where people can check doctors and enroll online) … You might be eligible for subsidies to help you pay for that insurance.”

Q: But do rates go up?

“If you’re in an employer-based plan, your rates shouldn’t be affected one way or another, especially if you are in a large employer-based plan. If you’re an individual trying to buy it in the marketplace, whether your rates go up or down depends on how healthy you were to start with and how old you were.

“If you were young, your rates may go up a bit. … If you are older or had pre-existing health problems, your rates should go down considerably.”

Q: What about Medicaid?

“The Supreme Court upheld the Medicaid expansion. … [A family of four making $30,000 a year or less would be able to qualify Medicaid]. What the Supreme Court said though is if a state decides not to do that Medicaid expansion, there is no penalty to the state. So in effect it makes that insurance expansion somewhat optional for the state.”

Q: What about illegal immigrants?

A: “The bill isn’t universal coverage. It doesn’t provide health insurance coverage to everybody. What it does is make it more affordable to most people. The bill does not affect coverage for undocumented immigrants at all. They get nothing different from what they already had.”

Q: Will quality decrease?

“I actually think one of the benefits of this legislation is there is better emphasis on quality. [The legislation says] ‘we need to get better value for the dollars we are spending.’ And the way it does that is it says, ‘We are going to define what it means to provide quality care.’

“We’re going to make providers measure what they are doing, and we are going to make that available to the public.”

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