Play Live Radio
Next Up:
Available On Air Stations
Watch Live


How Has Health Care Reform Law Affected U.S.?

How Has Health Care Reform Law Affected U.S.?
This week marks the one year anniversary of the Patient Protection and Affordable Care Act, also known as the health-care reform law. We'll discuss the impact the law has had over the last year, and talk about why it remains controversial.

This week marks the one year anniversary of the Patient Protection and Affordable Care Act, also known as the health-care reform law. We'll discuss the impact the law has had over the last year, and talk about why it remains controversial.


John Warren, editor and publisher of San Diego Voice & Viewpoint


David King, editor and founder of San Diego Newsroom

Bob Kittle, director of news planning and content for KUSI

Read Transcript

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.

ALISON ST. JOHN: It's regarded as most significant accomplishments of the Obama administration so far yet it's still so controversial that it has sparked some of the most heated arguments in Congress. For those living outside the beltway some people may be feeling the effects of healthcare reform is a change that might improve things way off in the future by 2014. But not yet. We'd like to hear your perspective on healthcare reform. Is it going to bankrupt the country or make healthcare more affordable? (888)895‑5727 is the number to call. And John start us off who is feeling the affects of health reform so far?

J. WARREN: Depends on who you talk to. I think we have several issues on the table here.  First one of my big concerns is the idea that we have changed the name of it from affordable healthcare to Obama care, and calling it Obama care has become a code word for attacking the plan. The CNN polls show this division in terms of support 50 percent or 59 percent they are saying are still against it as opposed to a year ago. But most people don't understand the legislation. Those who are beginning to see some benefit do. One of the good examples of the benefit is a whole idea that an adult child up to age 26 can still be covered in terms of a plan. Or the idea that children with preexisting conditions can no longer be denied care in terms of people being pushed out of the plan. And the idea of the doughnut hole being closed in terms of helping seniors who exceed whatever the allotment is for medical costs. All these things were built in the system with triggers so they kick in at different points. 2014 is a major point. Between 2014and 2019 we will see major activity with it. Certain elements are being grabbed to further create fear the idea that everybody must buy into the plan is being a considered a violation of the Commerce Clause. And we have 26 states now in court against the plan. So we have this confusion. And I think it's disingenuous and tragic that something that could mean so much to so many people is being torn apart with scare tactics in such a way as to stop it before it even has an opportunity. Yet what Obama has done with this legislation far exceeds anything that has happened through Truman or Clinton anyone else who has tried to approach of doing something for healthcare

ALISON ST. JOHN: Bob critics say on the one hand say we can't let government run our healthcare system, but on the other hand they say it's a huge burden, this healthcare reform plan, on small businesses. You cannot have it both ways who should run it? Can business really pay the cost or is in fact undermining US competitiveness in the global market?


B. KITTLE: I agree with John most people don't understand this legislation inuding those who enacted it. It's so complex and far reaching and no one can predict accurately the consequences of this legislation. But I will note that the CEO of Starbucks has said we need amendments to this.  Starbucks provides healthcare to its employees.  He is very concerned about the costs to this corporation. The cost to small businesses certainly will go up. Whether this decreases American competitiveness or not, I don't know. But I think there is no doubt this is going to cost the country dearly. It will cost individuals and small businesses and large businesses and it's going to cost the taxpayer. There is no way to have this massive government intervention in the healthcare system with basically guaranteed care for everybody without it costing a lot more money.

ALISON ST. JOHN: (888)895‑5727 is our number at the Roundtable and John is calling us from San Diego

JOHN: I'd like to ask John Warner no matter how controversial it is on a national level you see a lot of individual states trying experiments. Massachusetts had its bill. The state of Washington now has a medical panel that reviews clinical procedures and judges them whether they have proven clinical outcomes before they approve the procedures for state reimbursement. I wonder if he sees the cost aspect of this driving individual states to start doing reform type of efforts no matter what is going on with the national debate.

J. WARREN: I think Massachusetts was one of the first places to get started even before the bill came up. There were savings that were seen in that particular instance. But it has a lot to do with how the components within the state come together in terms of support.  We also see in this bill there are additional federal dollars as I understand it going to help those states that try to set up plans and so I see a projected savings. They are saying that in the first ten years the offsets in savings should exceed a hundred million dollars. [BREAK IN THE TRANSMISSION] There are exemptions for those with 50 or fewer employees and there are a number of options here that are not being fully explored in relationship to each state. So I wish I could be more definitive.  But I think we have to look at each separately just as Massachusetts was successful I'm not sure where Washington is going to be with their approach.

ALISON ST. JOHN: Good question John. (888)895‑5727 we would love to hear your opinions and questions here.  Because healthcare is tied to employment thousands of people who might choose to work parttime are forced to work full time to get health coverage. If you decoupled healthcare from you job wouldn't that open up the job market like nothing else?

D. KING: It could. What we have here is a giant package of legislation, a thousand different laws all rolled into one. America has wonderful healthcare science and the actual services that are delivered are as good as anywhere in the world. What we have is an absolutely abhorrent system for delivering healthcare and divvying it up to people. The process of taking a thousand different Band‑Aids and rolling them all together in one big law so we can have a celebration and say we have solved the health care problem was absolutely the wrong approach to take. If you incrementally move along and take one provision at a time think of about it thoroughly and don't inject this enormity of uncertainty into the marketplace. As a small business owner it makes it difficult. You try to manage your healthcare costs. You call your broker and they don't know what the policies are going to be the next month. It makes things more difficult for a small business owner with this degree of uncertainty about what the law is.

ALISON ST. JOHN: The argument was with all these different moving parts each moving part depended on the other moving parts to balance it out to make it work so you couldn't roll it out incrementally because it was a whole

D. KING: If they wanted to make a simple change like letting 26 year old people stay on their parents' healthcare, pass that and see what the affect is. If they want to have a change to fix the doughnut hole fix that. No reason to roll all of these different Band‑Aids together and think that is going to solve the problem that we have..

ALISON ST. JOHN: On the other hand it is being rolled out incrementally in some degree.

D. KING: It was passed in one big lump sum. The insurance industry is itself uncertain. Healthcare administrators are uncertain about what the law is. The states that are subject to this thing even liberal states that would support this sort of things are seeking waivers to get out. Businesses are seeking waivers to get out. Unions are seeking waivers to get out. It's a degree of uncertainty that the market doesn't need today.

ALISON ST. JOHN: Which is always what characterizes change I believe. Here is Dale from San Diego calling us.

DALE: I wanted to put in a plug for the PBS documentary Sick Around The World. Everybody should watch that. That was really enlightening. Something that they pointed out on that documentary is all our competitors are already doing it. It's kind of a false point to say we might lose other competitiveness economically. We are the only people in the world who are wed to a job to keep insurance, wed to a job full time to keep our older college kids in insurance. Our system is absolutely ridiculous.

ALISON ST. JOHN: Thank you for that. We have a lot of people wanting to comment.

D. KING: I lived in Holland and called the doctor and told him what I had because a medical student living next to me diagnosed it just listening to my lungs. This is Holland a nanny state. They have national healthcare. He was going out to make house calls and he was not able to see me. I'm not Dutch not part of their insurance system. He have left a prescription for me at his office having never seen me. That would never happen because of the malpractice rules here.

ALISON ST. JOHN: I have to save anecdotal stories like this you can always find them.

D. KING: We have fundamental problems with our healthcare system that the laws did not address. Being able to buy insurance across state lines. Tort reform. There are more fundamental flaws with our system that even if we took their system and adopted it in America and had our malpractice laws, it would still be difficult to get cost effective care in America

J. WARREN: Those situations are what we refer to as universal healthcare in terms of countries. We are not talking about universal healthcare here.  Don't lose track of the fact we have over 49 million people without any coverage whatsoever. One thing that will happen under this program is that those people in that poverty threshold family of four, 29 thousand a year, they'll come under Medicaid program that will be some assistance for them. The very fact that we're reducing the number of people going to the emergency room for primary care is part of the projected savings that we have here.  We can't just isolate and pick off parts and pieces of it. You have to look at the total picture in terms of what is happening. By 2119 two thirds of the people in this country will have some health benefit that don't have any now. I think that is a very significant change.

ALISON ST. JOHN: Bob the Republican Party is determined to try to repeal this. But apparently a new poll from the Kaiser Family Foundation found fewer than 40 percent of American favor repeal regardless whether Republicans replaced it with an alternative. So isn't this a dangerous strategy for the Republicans to be pursuing

B. KITTLE: Politically it may carry some risks. The reality is while the House Republicans could repeal Obama care the Senate is not going to and the president would veto any legislation like that. So Obama care is not going to be repealed by the Republicans.

J. WARREN: Affordable healthcare you mean.

B. KITTLE: Forgive me, John. I didn't consider that term, Obama care, to be pejorative but I will take it from you that it is.

ALISON ST. JOHN: If is it works it could be a compliment.

B. KITTLE: Like Reagonomics which was considered pejorative in the beginning but now ‑‑

ALISON ST. JOHN: Let's call it affordable care.

B. KITTLE: Ok, whatever. Healthcare reform. So, politically I think this is all over the map. The polls are all over the map on this too.  People don't want it repealed but a majority oppose it anyway. Again it reflects people don't understand this legislation and they are uncertain about what it's going to mean for them.

ALISON ST. JOHN: Maybe part of the reason people don't repeal this is because they are not seeing anything better being proposed by the Republican Party. What about the constitutional issue that you can not mandate everybody to get health insurance? If you can mandate car insurance why can't you mandate health insurance?

D. KING: Driving is a privilege. People don't have a right to elect not to have a human body. It's different. So this is completely different than anything that our founder would have conceived

ALISON ST. JOHN: We have come up against the end of the show. Thank you very much. Bob Kittle, John Warren and David King. Thank you so much for listening to Editor's Roundtable here on KPBS. I'm Alison St. John. See you next week.