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Debating Impact Of Health Care Reform Law

The hallway leading to the emergency department at a San Francisco-area hospital.
Mark Coggins
The hallway leading to the emergency department at a San Francisco-area hospital.
Debating Impact Of Health Care Reform Law
What effects has the Patient Protection and Affordable Care Act, also known as the health care reform law, had since it was passed one year ago today? Why is there so much confusion about the law's impact? And, what provisions of the law will go into effect in the future? Local advocates for and against the law debate its impact.

What effects has the Patient Protection and Affordable Care Act, also known as the health care reform law, had since it was passed one year ago today? Why is there so much confusion about the law's impact? And, what provisions of the law will go into effect in the future? Local advocates for and against the law debate its impact.


Gregory Knoll, executive director Consumer Center for Heath Education and Advocacy, which is an independent program of the Legal Aid Society of San Diego


Ron Nehring, Chairman Emeritus of the California Republican Party

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This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.

MAUREEN CAVANAUGH: I'm Maureen Cavanaugh and you are listening to These Days on KPBS. A year ago on this date Pres. Barack Obama signed the affordable care act into law. Its aim is to decrease the spiraling cost of health care and at the same time make healthcare more accessible to the millions of Americans who can't get or cannot afford health insurance. Since last year's signing several provisions otherwise gone into effect and have been generally well received but the law's major proficient requirement that all Americans must buy some form of health insurance by the year 2014 has been and is being challenged in court. Joining us for an update on this one-year anniversary of the affordable care act. My guests Gregory Knoll is executive director of consumer Center for health education and advocacy which is an independent program of the legal aid Society of San Diego. Gregory, welcome.

GREGORY KNOLL: Thank you, Maureen for having me.

MAUREEN CAVANAUGH: And Ron Nehring is chairman emeritus of the California Republican Party. Ron, good morning and thanks for coming.

RON NEHRING: And great to be here.


MAUREEN CAVANAUGH: Let me start with you Greg, just tell us what some of the effects that we've seen so far from healthcare reform law since it was passed a year ago.

GREGORY KNOLL: I think without question that this piece of legislation is probably the most important piece of social legislation we've had since the 64 and 68 Civil Rights Act. Probably the best thing it's done for the working person, the everyday person who is trying to get by and trying to have quality health care is he sending some of the long standing insurance company abuses. About 196,000 young adults in California can now stay on their parents plans. 18.8 California residents with private health care coverage no longer have an insurance company imposed lifetime. They can no longer discriminate against children with pre-existing conditions this is now but in 2014 that will be extended to all of us. If you join a new plan where you are one of 4.5 million California Medicare beneficiaries preventative services such as colorectal screening, mammograms are now with no copayments or deductibles and one of the reasons that is important is for access great many seniors because if they were co-pays or deductibles would then eschew them and do not get them and that would be a good thing.

MAUREEN CAVANAUGH: As I said in the opening, Ron, many of the provisions of this law that have rolled out so far have been received rather favorably. And yet the opposition to this law is still very strong and I'm wondering if you could explain it to us. Is there a disconnect there or does it all make sense?

RON NEHRING: I think that you raise an important point and that is that perhaps the most visible report of Obama care being signed into law is that the Democrats are in the minority in the House of Representatives in large part because the disaster area of legislation is deeply unpopular with the American people who don't like the idea of the people who run the DMV having more say in their MRI than they did before. In terms of themes that you pointed out which were cited as the reasons to do this in other Congressional Budget Office estimates that within just a few years an insurance policy is going to cost to $2100 a year more for a family than it would've cost of the bill did not pass. So all of the superfluous arguments, all the window dressing that was used to justify this in the first place simply are not materializing. Then of course we have 21 new taxes which have been imposed as well and the American people understand that our health insurance system needs improvement, can use improvements but the question becomes do we expand the role of government in order to accomplish or do we improve our health insurance markets and give people more choices and a patient centered approach and I think it is a disconnect that leads to the fact that Americans still want to see this bill repealed. House Republicans move forward with that and the Democrats to automatically set by legislation which the American people don't want.

MAUREEN CAVANAUGH: But still the fundamental point is that the things that have already rolled out for the healthcare law are popular.

RON NEHRING: Most of that could've been done without the monstrosity of legislation. If those popular items were so important to do than why attach good ideas to a bunch of bad ideas. Why attach expansion of allowing young people to stay on their parent's health insurance plan for example why do you have to attach that to 21 new taxes. Why do you have to take people's self savings accounts away or at least increase the penalties for people to use health savings accounts that has a negative impact on folks like those of the new taxes which brick Obama's pledge not to raise new taxes on anyone making over $200,000 a year. If there are good things to do list of the good things not to do bad things that put the government further in charge of your health insurance.

MAUREEN CAVANAUGH: One of the things that do show that public opinion polls as there is a lot of confusion about this law and how it rolls in and what it's going to do and is that confusion in and of itself something that is damaging to acceptance of this healthcare reform law?

GREGORY KNOLL: Sure. I think there are many people in this country who like to confusion and like to confuse folks so that they might believe this is some governmental plot to take over healthcare. The fact is that we keep talking about the American people want this and that. Well I talked to them or can people do. And many of them who has been going broke trying to take care of their children with pre-existing conditions because they can't get health insurance are now insured, the kids are insured so there are a lot of people that do not want to see this repealed. There's a few other things are going on to, about 503,000 California small businesses are going to be eligible for tax credits if they keep providing health care coverage. This is important because the small employers have an 18% on average higher premium than two large employers that this will give them a bridge to 2014 when they will be able to go into the exchange and get the same prices as large employers. I mean, one of the things that people I talk to, what they are mad about is that employer premiums have risen three times faster than wages in the last 10 years. Yesterday the CEO of Pfizer was unceremoniously left Pfizer pharmaceuticals and was given a $22 million retirement package. The Americans I talk to don't like that they like to be covered. Like to have access to coverage and prescription drugs and like to do it in an organized fashion.

MAUREEN CAVANAUGH: To Ron's point in the recent election many of the Republicans who won, campaigned on appealing healthcare reform how do you explain that.

GREGORY KNOLL: I think they also ran on cutting back government in any way. I think there was a reaction that I think was fueled partly by the confusion, Maureen.

MAUREEN CAVANAUGH: Okay I wanted to ask you to, Ron, you made a point that a lot of the things people like about this law could have been done another way, so why haven't they been done another way. I mean, the Republicans ran Congress, both houses for the early part of the 2000s. Why did it take this reform act to bring in the good changes that people like and if indeed it was repealed, what would your answer be to do anything about healthcare?

RON NEHRING: Two things. First I think that if this law is so great and so wonderful that I have over 1000 organizations mainly labor unions petitioned for waivers from the loss owner as requirements could certainly our health insurance system can use and met with Obama care needs even more reform so we can have greater consumer choice, but I think one of the things that's overlooked that many of the failings of our health care system are caused by government regulations in the first place. Caused by mandates in the first place. For example someone in California you can't buy a insurance plan from a company in Arizona you cannot buy insurance across state lines. People are limited in terms of their choices so we should expand choices for people to buy health insurance policy that covers pre-existing conditions or things like that but I think if you come to the basic premises of why this law was passed from your introduction which was to get health insurance costs need to be brought down and so on, when the government intervenes in the sector rarely does it cause real prices to come down. What results often is in cost shifting and so on and we know that health insurers are going to need to increase their premiums between one and 9% that is a direct result Obama care in contradiction to the stated goal of the legislation which is to reduce costs so it's open choice, give people more options, more alternatives and let's not have the government come in and say for example if you have a good health insurance plan the government will come along and say that is a Cadillac plan, that's more coverage than the government thinks you should have so we will impose a 40% tax on a portion of health insurance plan. That's not a good idea but does not expand choice and all of this.

GREGORY KNOLL: Maureen, I think you're exactly right when you asked the question. The problem in this country has been we needed to push to bring us into line and be the last country in the free world to recognize that all of our citizens need access to quality affordable health care coverage.

RON NEHRING: But this law doesn't do that----

GREGORY KNOLL: That's exactly what this law intended to do.


GREGORY KNOLL: I let you talk, okay?

RON NEHRING: Okay great.

GREGORY KNOLL: The whole idea of this legislation is that we are the last country to do so could you not begin to fix things until it becomes the law of the land that people are entitled to healthcare. The problem that come it took France 26 years to cover everybody. This is a process. But someone had to start the process. Because as you pointed out, the other side has absolutely nothing to offer. Has never put a bill in about expanding health care coverage. We're going to expand health code coverage in San Diego alone starting in July by 29,000 people.

MAUREEN CAVANAUGH: Want to ask you more about that but you wanted to comment about, this doesn't cover everybody? So what is the plan to cover everybody that you have, Ron.

RON NEHRING: I think first we have to take a step with where are we now and what is the best pathway forward to improve our health insurance markets and choices. And the first thing we need to do is make sure that people are given options and alternatives in a market where, which actually operates properly as opposed to one which is so overregulated and so overburdened right now that people don't have that opportunity. We see these arguments come from the left that well, we need to have a public option for example which the note left at the desk ~~don't try to force back into this but I don't understand why is it that the government has to be in the business of providing health insurance as opposed to white doe we say the government has to open the supermarkets and so on. There is a role here for government certainly and that is to make sure that people have access to competitive markets because it is those competitive markets which drive costs down Breitweiser for example that while health insurance premiums will go up as opposed to down as promised under Obama care the one sector of the health insurance market where costs to come down easy and elective surgeries. Because that is where individual choice comes into play and there is actual competition helps to drive the costs down and drive quality of the first place.

MAUREEN CAVANAUGH: I want to ask both of you gentlemen, we are having this debate again on the one-year anniversary of the healthcare law, and I wonder if indeed this is really just, I suggest, and ideological dispute. In other words, if the practical benefits of this affordable health act actually can be demonstrated, I wonder if there would be an indigenous debate or if it would continue on because they would be your contention, Ron, that the government should not be doing this whether or not it works.

RON NEHRING: Well certainly, it is interesting when you cite this as the affordable care act, and yet it's not making health care insurance more affordable.

MAUREEN CAVANAUGH: That is the name of it.

RON NEHRING: That is the name of it but does not start with you when you put a label on something and it doesn't live up to the label that the proponents got to choose in the first place? We want to make sure that Americans can buy quality health insurance and that they are free to do so. What doesn't make sense is to have the government step in and say the insurance policy is good in our mind or the insurance policy is too good in our mind and therefore we will tax the poor. Republicans put into effect a health savings account so that people could have money set aside which they could use to pay for routine medical

GREGORY KNOLL: Doesn't do anything to improve care.

RON NEHRING: I'm sorry you are pointing out that you let me talk, so I'd appreciate that.

GREGORY KNOLL: Yes but you've talked for 10 minutes.

MAUREEN CAVANAUGH: If you could finish your thought, Ron.

RON NEHRING: Health savings accounts are a good thing. Many Americans use them, this pullback on people's ability to pay for routine medical expenses out of their health savings account. It's not expanding choice.

GREGORY KNOLL: I love the way the other side continues to talk bad about government regulation. Yesterday Blue Cross pulled back from its 30% rate increase. Because of the scrutiny that increase underwent. That is saving money. Bring in Blue Shield, if you look at all of their plans for private coverage individual coverage are looking at an 85% increase and they are not pulling back. The problem that you have right now is a lack of government regulation. The last time these folks were talking about, we've got too much regulation was in the mortgage and banking crisis. How is that working for this country right now? You've got to have some government regulation to take 40 million uninsured people and get the coverage they not only deserve, but that would make us healthier nation.

MAUREEN CAVANAUGH: I will give you a chance to respond but I do want you to give us the numbers so we can bring it back to the people. Do you have numbers on how many people in San Diego have been affected so far by the provisions that have unrolled in the health reform law?

GREGORY KNOLL: California total numbers?


GREGORY KNOLL: Let's go back to San Diego for a second as I said before one of the options with the act is to get a waiver so that counties and states can begin to implement earlier than 2014. Our county along with many counties in California have chosen that option. And as soon as the terms and conditions of the contracts are signed we will be expanding coverage in San Diego to 29,000 minimum people starting in July. All economic models indicate that the affordable care act just through its expanded coverage alone in San Diego will be a $4 billion boost to the San Diego economy due to increased business activity. What people don't understand is that if you try, this is the complicated part, if you try to take away this act you are also taking away a budget deficit reducer according to my friend cited CBO of $143 billion which we have in 2019.

MAUREEN CAVANAUGH: Yes, your chance to respond, Ron. I had to let him get the San Diego numbers in.

RON NEHRING: I think one of the issues here is the intangible effect this has on job creation going forward grid anytime you're going to impose a mandate, this employer mandate tax which begins in January 2014 are most directly going to impact small businesses which are already disadvantaged here in California. The larger employers here in California many of whom are leaving or building facilities elsewhere, large employers have the ability of scale, small businesses don't have that much ability so they are disproportionately impacted by deceptive and we've already seen this anemic jobless recovery so to speak, and one of the reasons we have the jobless recovery is that small business owners are concerned about what are they going to be hit with next. What is the impact of this Obama care law going to be on their ability to function as a business going forward. So you might be able to say look at the tens of thousands of people will benefit but at the end of the day if it directly impacts our ability to generate jobs, which it does then I ultimately is going to help people in terms of the overall well-being of their family. So that is intangible.

GREGORY KNOLL: But the CBO office disagrees that it will not create jobs. They project twice as many people within five years being able to be seen by community health care Sue will double their capacity in five years.

MAUREEN CAVANAUGH: We are going to be out of time in just a moment and I would really like to get both of your quick assessments out. As these assessments continue to roll out, Do you see the second anniversary of the affordable health care act do you see as you go into the presidential election of 2012, do you see this continuing to be a major perhaps divisive issue in our politics?

GREGORY KNOLL: Sure. I care mostly in my daily work life not about politics, but about covering people. I see the devastation that people go through for lack of healthcare. The fact that the 45,000 people, Maureen, die every day, I'm sorry, die every year because of a lack of health insurance. That is unconscionable in a country that has so much largess. But I do believe that there will continue to be distortions because the worst thing that could happen to those friends to my right is that Pres. Obama might have a successful program that rolls out.

RON NEHRING: I would define success as having our markets driving costs down as they do in every other part of our economy. The Democrats say that they want to allow more people to get health insurance but we see that rates will go up by between one and 9% we don't get why people more health insurance by driving costs up by putting my mandates on people or regulations on folks invite you bring the economic recovery through those mandates, the 21,000 IRS mandates, the 27 taxes that violates Obama's mandate not to increase taxes with people making $200,000 or more a year.

MAUREEN CAVANAUGH: I want to thank you both. This is going to continue. Greg Knoll, Ron Nehring, thank you for speaking with us today. I really appreciate it. If you would like to comment please go online to Days. Stay with us for hour two of These Days coming up in just a few minutes on KPBS.