Panelist describes health care reform as question of time, money, the unknown

State Sen. Joe Hardy decided Tuesday that performance art could best describe how the new national health care law would change the system.

During a panel discussion he pulled a couple of strands of cold, cooked spaghetti from a plastic bag and flung them against the wall behind him. They remained there through the rest of the event.

"The federal government comes up with ideas but they don't know how to make them work," said Hardy, also a physician. "The states become 50 independent laboratories to see what will stick."

At that, he expressed a more tangible idea of what will come than did other members of the Nevada-oriented panel at the annual Nevada Health Care Forum on Tuesday at the United HealthCare campus in Las Vegas.

"The answer to almost everything about health care reform is, 'We don't know,'" said Larry Matheis, the executive director of the Nevada State Medical Association, the physician's group.

One effect seems relatively certain: The number of people relying on government-funded medical care will grow. Currently, 320,000 people fall under the state's Medicaid program for the low-income and about 500,000 go uninsured.

Mike Willden, director of the state's Department of Health and Human Services, said the Patient Protection and Affordable Care Act signed into law last year could funnel close to 200,000 more people into Medicaid. Many others may have to go into exchanges designed to provide policies for people who can't get them through employers. Both programs will be backed by federal dollars, but the amounts are still a mystery.

In his department, Willden said, people talk about health care finance changes as questions of time, money and the unknown.

"There is a whole lot of unknown right now, so we don't know if we have time or money," Willden said. "To use a Nevada term, it's a crapshoot."

The panel members agreed that once the details of the new law become clear, assuming it survives a legal challenge heading to the U.S. Supreme Court, companies with more than 50 employees will carefully calculate whether it costs more to provide health plans or pay the $2,000 per employee federal penalty and send them into the exchanges.

Nevada Hospital Association CEO Bill Welch predicted that as more people join the Medicaid rolls, people with private insurance will pay more in a continuation of the years-long practice of cost-shifting. Now, he said, Medicaid covers 58 cents of every dollar hospitals spend caring for patients, so hospitals recoup the difference by boosting what they charge private insurance.

With more people on Medicaid, he said, reimbursement rates will fall even more and place a larger burden on private insurance.

Contact reporter Tim O'Reiley at
toreiley@reviewjournal.com or 702-387-5290.