Rotary Report: Lemen explains complexities of Affordable Care Act

Rob Lemon of www.accessehr.com at Martinez Rotary. He explained the complexities of the Affordable Care Act (Obamacare). (PAUL CRAIG / Courtesy)
Rob Lemon of www.accessehr.com at Martinez Rotary. He explained the complexities of the Affordable Care Act (Obamacare). (PAUL CRAIG / Courtesy)
By PAUL CRAIG
Special to the Tribune

The Affordable Health Care Act (Obamacare) is extremely complex. It’s causing massive change in the way the nation handles health care. It was enacted by Congress after huge debate and much compromise.

In the long term it will make health care better. So says Rob Lemen, president of Accessehr.com, a local company specializing in insurance services. Rob’s a long-time Martinez resident and Bocce activist. He’s well known in our community. He knows his stuff. Rob explained some of the complexity to Rotary, leading for calls to bring him back again for another talk.

It’s helpful to separate national issues from individual issues. According to Rob, there are two bottom lines for individuals: 1) If you don’t have insurance, get it; 2) if you plan elective surgery, ask your doctor to make sure that everyone involved is covered. “Everyone” includes anesthetists and specialists who may be called in. Get assurance from your doctor, in writing.

Else you may discover that you’re responsible for a portion of the costs. For a complex operation, this may be a lot. If your physician can’t or won’t provide written assurance that everyone and everything will be covered, you should consider finding a new physician.

Check on how much you may have to pay in an emergency. For most policies, coverage will be extensive and the direct cost to you low. But – and it’s a big but – you may have bought a policy with a large deductible. Find out how large. You may want to shift to a more expensive plan with a lower deductible. As the amount you’re willing to pay goes up, the cost of a plan will go down. How risk-averse are you? How much can you afford in an emergency? Do your homework!

Those are the messages for individuals.

Viewed nationally or at a state level, the situation is incredibly complex and changing all the time. Critical elements vary from state to state. A new California law requires that insurance companies pay out 80 percent of their premiums. Overhead is legislatively held to 20 percent. Historically, overhead has often been much higher. The new law is putting insurance companies under lots of pressure. This is leading to staff cuts and service delays. Top executives continue to receive salaries in the many millions per year.

As Obamacare kicks in, between 8 and 14 million folk have coverage who had none previously. Under the new law, insurance companies cannot make insurance contingent on being healthy. Regardless of your preconditions, you can get insurance. That’s good news. America is, at core, a caring society. The Affordable Care Act reflects that.

On the other hand, lots of people – especially young and healthy ones – are not buying insurance. They pay a penalty, but feel it’s worth it. Opting out by these folk is hurting the overall economics of the plan. It’s way too early to tell how all this will settle out.

One thing that’s clear is that the overall cost of health care will continue to rise. The U.S. pays more per capita for health care than any other nation. Health care costs about 17 percent of gross national product (GNP). For comparison, the World Bank figures the world average is about 10 percent of GNP. Health care costs have long increased faster than most other sectors. Lemen says that international comparisons are difficult and can be misleading. The U.S. is much more inhomogeneous than other nations. We have lots of state-level laws. We do lots more research and develop far more drugs and procedures than other nations. Most of us have better access to experts than do people in other nations. Because of the high quality health care available here, people from other nations frequently come to the U.S. for medical care. They get faster and higher quality service.

Rotarians were a bit dubious about some of these claims. Perhaps the U.S. is simply less efficient than others. Perhaps we spend more on “paper pushing” than they do. Comparisons are hard to make. National controversy about the Affordable Care Act is reflected locally. That’s why Rotary wants Rob to talk to us again.

Check www.martinezrotary.org for this and other talks. We invite visitors. Especially visitors who may be interested in joining Martinez’s premier service club.

Incoming Rotary President Denny Horack dedicated this year to the memory of Rotarian Jay Archibald. Jay’s loss hit us all hard. We loved the guy. We miss him.

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