Obamacare’s author defends law in Denver

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DENVER — Zeke Emanuel, considered one of the architects of Obamacare, touted the law’s benefits here Thursday morning at a forum sponsored by the Denver Post and University of Denver and in an interview with FOX31 Denver.

“We’ve had cost control problems in our healthcare system for 40 years,” Emanuel said during the forum. “Our healthcare system is the fifth biggest economy in the world. Limited access, uneven quality and uncontrolled cost are the three reasons why President Obama committed himself to this cause.”

Emanuel, the older brother of Obama’s first White House Chief of Staff and current Chicago Mayor Rahm Emanuel, said it’s still too soon to assess the impact of the landmark law, some of which has yet to take effect.

“By the end of the decade, by 2020, you are all guaranteed to have a much better healthcare system because of the Affordable Care Act,” he said. “Everybody in America will have access to health coverage.”

On the Individual Mandate

Emanuel also defended and explained the individual mandate, upheld in a 5-4 Supreme Court decision handed down in June, arguing that it’s an essential mechanism in order to force insurers to cover all Americans and to keep premiums low.

“I understand many people don’t sit well with the mandate,” he said. “Americans don’t like to be told what to do. But let’s be real. You cannot prohibit insurance companies from not covering people with preexisting conditions without the mandate. That’s why we fought for it.”

Linda Gorman, a policy analyst at the Independence Institute, a conservative think tank based in Denver, offered a counter-argument against “Obamacare” at the forum.

“I think Obamacare needs to be repealed and replaced,” she said.

Gorman took issue with the individual mandate, which will force all Americans to buy health insurance by 2014, and also with the mandate forcing any business with 50 or more employees to provide healthcare for its workers.

“What gives you the right to say whether I’m a small business and whether I should be forced to pay thousands of dollars for healthcare?” Gorman asked Emanuel. ‘

“This is a very bad deal for business owners. You’re taxing businesses’ capital for investment that they can use to hire more people. If I’m a business with 49 people, I’m not going to hire that 50th person. It’s just a bad deal for job creators.”

Emanuel responded by saying there isn’t a penalty for businesses that don’t offer insurance plans for employees.

“And if a company is 100 people, maybe it’s not a ‘small business’; maybe it’s time they step up and help their employees get coverage.

On financial incentives

Both Emanuel and Gorman believe that changing the incentives that drive behavior in the health care market is important, but they disagree on which incentives should be adjusted.

In Gorman’s view, government should work to give Americans more control over their health care and less dependent on insurance policies and premiums.

“If you make Medicare look more Iike a private healthcare plan, people will find more reasons to cut costs,” Gorman said. “You have to change the incentives and make consumers more likely to be smarter with their healthcare dollars.

“If you let people put as much of their own money in as possible, they spend their money more wisely.”

She argued that limits on what insurance companies can charge and forcing most health care to be delivered through insurance programs drives up costs overall.

“We don’t know how much healthcare people need. Why are we spending a bunch of money on health and wellness programs when we don’t know if they work? You should let people decide how much care they need, not force everyone to buy employer plans that are larded up with things we don’t need.”

Emanuel agrees that changing incentives for consumers is important, but that changing incentives for hospitals and doctors providing care is paramount.

“Right now, hospitals have incentive to do more treatments and more expensive treatments,” he said. “Unless we change that, were not going to change what we do. With the Affordable Care Act, we are incentivizing them to change how they care for people so the don’t just wait for people to get sick before they care for them.

“Spending in the healthcare market is uneven. Fifty percent of the population, healthy people, account for just three percent of the cost of healthcare. We need to focus on the ten percent of the population who are sick and to incentivize doctors to treat them earlier, before they get sick.”

On healthcare exchanges

Emanuel argued that state-based healthcare exchanges, online marketplaces where consumers will be able to compare policies and rates starting in 2014, will offer consumers the kinds of options Gorman argues they deserve.

“The purpose of the exchange is to provide individuals with a wide variety of plans at different levels and to give them subsidies to be able to afford it,” Emanuel said. “It is a very market-friendly, efficient place to get coverage.”