By Maria-Jose Subiria
As the sun was rising early Thursday morning, President and CEO Stephen Mahan, of the Southern Regional Health System, updated business professionals on the new reforms taking place under the federal Affordable Care Act, and the possible effects they may have on local businesses, hospitals and communities.
Mahan, who is responsible for an institution with about $270 million in annual net revenue, was the keynote speaker for the Clayton County Chamber of Commerce's "SunTrust Early Bird Breakfast." He talked about the importance of being aware of changes that health-care reform will bring to the nation.
"All of you have heard the debate, and all of you need to pay close attention as [seekers] of healthcare, as business owners and individuals who are making decisions for health-insurance coverage for your employees, because we are about to embark upon a radical change in healthcare," he told the audience.
He said there are two sides to the debate. "It boils down to the fundamental issue of, is healthcare a right, or is it a privilege?" While healthcare is essential to humans, he said, healthcare costs may prevent individuals from obtaining the medical care they require.
"How much does it cost to do that [get treatment], and are we [hospitals] going against quantity of life, versus quality of life?" he asked. He said that, currently, health-care expenditures are 19 percent of the nation's gross domestic product, and by the year 2020, healthcare will consume 30 percent of it.
According to Mahan, the Affordable Care Act attempts to get to the heart of the current problems of American medicine. He said that in American medicine, the more doctors do for a patient, the more they charge. Doctors, who treat a person who has Medicare or Medicaid health insurance, receive a Diagnostic Related Group (DRG) pricing, which is a fixed payment, no matter how much work they do on the patient, he said.
"It is going to cost more to take care of you, and I am going to lose money," said Mahan, of how some medical professionals may think under a DRG pricing situation.
According to a federal government web site -- www.healthcare.gov -- by Jan. 1, 2015, physicians will be compensated for their services for the quality of care that they provide to a patient: Doctors, who provide a higher quality of care, will receive higher payments.
"There is going to be integrated systems, so that we can start standardizing care," he said. "We can reduce care, we can reduce costs," he said.
Mahan added that President Barack Obama's health-care plan is not yet fully funded, however, and after the Nov. 2 elections, there may be some changes in the United States House of Representatives, if the Republican Party gets control. That could affect several of the provisions of the act, he said.
The comprehensive health-care reform law was enacted in March 2010, and the first reforms began this week, according to the government web site managed by the U.S. Department of Health and Human Services.
"September 23, 2010 represents a new day for American consumers in our health-care system," the web site states. "This is the day that a series of new rights, benefits, and protections under the Affordable Care Act begin to bring to an end some of the worst abuses of the insurance industry."
According to the web site, under changes brought by the new law, insurers will no longer be able to:
* Deny coverage to children with pre-existing conditions.
* Put lifetime limits on benefits (i.e. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions such as cancer).
* Cancel your policy without proving fraud.
* Deny claims without a chance for appeal.
Yulonda Beauford, president and CEO of the Clayton County Chamber Commerce, said that, since the act has just taken effect, it is still developing, so businesses are going to have to manage through constant changes.
"It is very early, because of the upcoming, November elections," said Beauford. "This is such a political issue, that it is going to constantly change."
For more information about the Affordable Care Act, visit www.healthcare.gov.