Dr. Steven Bruner, of Lawrence Family Medicine & Obstetrics, confers Monday with patient Carol Glover. Bruner says he’s happy that the health care reform bill has passed. “I am very thankful that there are some politicians who actually have a little bit of courage to see this through really hard times.”

Those working in the Kansas health care industry lauded federal health reform legislation that is being signed today by President Barack Obama.

From doctors to Kansas Insurance Commissioner Sandy Praeger to an insurance representative, everyone seemed to agree on these four things:

1. It’s a historic step in the right direction to fix a system that is greatly flawed.

Dr. Steven Bruner, of Lawrence, said, “It is just embarrassing as a citizen of this country to think that people are dying and going bankrupt because we can’t devise a health care system that gives everybody access to care.”

1. It will need further work in addressing a number of issues such as tort reform and containing costs.
2. If you have health insurance and you are happy with it, the bill won’t change your care or coverage.
3. There’s still a lot of work to be done at the federal and state level.

“The devil’s going to be in the details going forward,” Praeger said.

Here’s what some of our area’s health care leaders had to say Monday:

Sandy Praeger — Kansas Insurance Commissioner

“It begins to fix problems in the marketplace that have to be fixed,” she said. “First of all, we have to get everybody covered in some fashion through Medicaid expansion or by reforming the rules in the marketplace, so people who need coverage can get it.”

Some of those rule changes take effect in six months.

For example, children and young adults up to age 26 can remain on their parents’ insurance plan. Insurance companies can’t have lifetime caps on coverage. They also can’t deny coverage to children with pre-existing conditions.

Praeger said the most important provision in the bill won’t kick in until 2014, when insurers won’t be allowed to deny coverage to anyone based on pre-existing conditions.

To do that, the bill requires everybody to have coverage.

The problem that Praeger expects is that the insurance costs for young, healthy adults are going to be higher than the penalty for not having insurance.

“I anticipate younger folks will pay the penalty and opt out, meaning we will lose one of the benefits of requiring everybody to have coverage and that is for healthier folks to buy coverage and help spread the risk,” she said. “That may not happen and that’s unfortunate.”

But Praeger hopes that will change in time. “There are still lots of areas that are up in the air,” she said.

Praeger is pleased the bill keeps regulations and oversight at the state level. She will be working with the U.S. Department of Health and Human Services on developing standards for the new state health insurance exchange.

Consumers are going have better information to compare policies, she said. The legislation also has added consumer protections. For example, the appeals process will include an internal and external review.

“It’s a start in terms of fixing the problems that do exist,” she said. “We can’t continue under our current system. We just have more and more people not being able to afford health insurance and that pushes the cost onto the insured population, meaning that more and more people can’t afford insurance. It’s not perfect, but nothing usually ever is.”

Dr. Steven Bruner — Lawrence Family Medicine & Obstetrics

Bruner, who has been a Lawrence doctor since 1976, said the health measure doesn’t solve all of the problems, but it’s an “excellent first step.”

“I am amazed that it happened and I am ecstatic that it happened,” he said.

Bruner said it creates a system that everybody can get into, which is key to holding down premium costs.

“When things get expensive, the people who drop are those who are healthier. Then, the pool is only left with those who are sicker and the rate has to go up,” he said. “If you can dilute the pool, which this legislation is designed to do, then you have a fighting chance to hold down costs.”

Bruner is hopeful that Congress will pass some provisions to the bill that will reimburse doctors who accept Medicaid at the same level as for Medicare, since it will expand the Medicaid program to cover more low-income people.

“You can live on Medicare, but you can’t live on Medicaid,” he said.

Bruner’s practice has six doctors. They each see about 100 Medicaid patients and they lose money on each of them. He estimated Medicaid pays half of what Medicare does.

He said boosting the reimbursement rate might increase the number of doctors who accept Medicaid and help lure medical students into primary care.

“Graduates will look at it as a more viable profession,” he said.

He said getting rid of the pre-existing condition exclusion is an important piece of the bill because it allows people to move to different jobs without fear of losing coverage whether they have diabetes or have had cancer.

If people don’t have coverage and that cancer returns, they often end up claiming bankruptcy.

“This bill is certainly not the best of all worlds, but it creates a much better system than what we had.”

Corrie Edwards — Kansas Health Consumer Coalition executive director

Edwards said the bill should provide insurance coverage for 230,000 Kansans by making insurance more affordable and by expanding the Medicaid program. There’s also a number of consumer protections.

“Plans can no longer terminate you if you get sick, and they have to let you in if you have a pre-existing condition,” she said.

Edwards believes the legislation has bumped up the importance of her job in educating consumers about their choices and rights.

She said work is still being done at the federal and state levels, but she is glad some reform has passed.

“I run a nonprofit, small business,” she said. “We’ve got a really good health plan. I am a cancer survivor. If I thought there was any way in the world it would jeopardize the health plan that I have, I honestly would not have advocated for it. I do not see this jeopardizing anybody’s current health insurance plans. I do not see that happening.”

Mary Beth Chambers — Blue Cross and Blue Shield of Kansas spokeswoman

The company, which insures about 902,000 Kansans, will spend the next several months making sure it complies with new federal regulations.

“It’s good to move past the rhetoric stage and get to that period where we can really get down to work,” she said.

Chambers said the company has endured a lot of changes in its nearly 70 years of business.

“When Medicare came into existence in the mid-’60s, people thought private insurance would go away at that time. That wasn’t the case at all,” she said. “We have every intention of remaining a viable insurance company for Kansans. So, we see that there’s great opportunity for growth.”

She said the legislation will allow more Kansans into the health insurance market, which will help spread the costs.

In January 2011, the legislation will require insurance companies to pay back 80 percent to 85 percent of premium health care claim expenses. Chambers said that wouldn’t be a problem for them because they already operate on less.

“With our business in 2009, we operated on less than 9 cents of a premium dollar. We paid back more than 91 cents in the form of health care claims,” she said. “We will do everything we can to keep that 9 cents low, but the true driver of health care costs is the 91 cents.”

Chambers said that hopefully premiums won’t go up, but they could because the legislation didn’t address costs of services and demand for services.

“Until we can work toward having more Kansans make healthier choices about eating right, moving more, smoking less — those sort of things to help combat chronic conditions that are frequently caused by lifestyle choices — that’s not going to control that cost factor too much,” she said.

She said premiums could be affected in 2014 when they no longer can deny anyone coverage who has a pre-existing condition. She said that works as long as everyone carries insurance.

“The jury is still out on whether the health care reform truly lowers the cost or increases the cost,” she said.

Gene Meyer — Lawrence Memorial Hospital CEO

Meyer described the overall premise of the bill — to provide coverage for those who are uninsured — as very positive.

But he has concerns and questions.

How much will the hospital and its providers be reimbursed for covering more Medicaid patients? It gets only about 20 percent to 30 percent of the costs now.

And who is going to provide care for the millions of people who will qualify for insurance?

“That’s really going to hit home at the primary-care-position level,” he said.

For people who have insurance, he thinks they may have to wait longer to see their doctors because of the newly insured population.

Meyer has heard that one way to financially support the bill is to reduce payments to hospitals and doctors.

“We are trying to figure out if the reduction in payments will be offset by the increases in payments when people become insured,” he said. “It’s going to be real interesting. I think how we are going to financially support such extreme measures longterm is going to be very challenging both to the health care industry and to the general public.

Nikki King — Health Care Access clinic executive director

King said the legislation is good news because fewer people will have to rely on the Lawrence clinic for medical care. It serves low-income, uninsured Douglas County residents.

Since opening in 1988, business has escalated. Last year, it served 1,431 patients, up 58 percent from just five years ago.

“Ultimately, the goal has always been for the clinic to go out of business, hoping that everyone has a medical home, a medical card, medical insurance — somewhere to go,” King said.

“The bad news is, according to this plan, it has only reduced our target market by half.”

So instead of having 14,000 uninsured Douglas County residents, there will be 7,000.

More people will gain access to coverage through more affordable plans or by qualifying for the Medicaid program, she said.

“There is the concern, of course, about whether there are enough providers who will take those cards. So we will see how that plays out in three years when this is fully implemented,” King said. “We will do business as usual until then.”