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The issue of access
The healthcare reform bill has passed the House, but questions remain about whether reform is enough
Phillip Schaengold, CEO of Memorial Health

Last week the Affordable Healthcare for America Act won a narrow vote in the House of Representatives, 220-215. But as critics and supporters alike continue to sift through the bill, which is nearly 2,000 pages long, questions remain about the impact it will have, and whether the reforms will actually increase access to healthcare in the United States.

What everyone can still seem to agree on is that reform is necessary. According to a report on, one in every four dollars in the US will be spent on healthcare by 2025 if the system is left unchanged.

Congressman John Barrow, who represents the 12th District, an area that stretches from Savannah to Augusta, voted against H.R. 3962, seemingly despite the needs of his constituents (about 21 percent of whom are uninsured).

In an op-ed he released after the vote, Barrow, who has been critical of reform measures, wrote, "The House bill does a fair job of helping people buy the insurance they can't afford now, but at a higher cost than would be necessary if we adopted tougher regulations for the health insurance industry."

The problems with the healthcare system run much deeper than the insurance industry though.

"We face crises of access, cost and quality," says Phillip Schaengold, President and CEO of Memorial Health.

Last Thursday, Schaengold addressed a packed house of business and community leaders during the Critical Issues Forum, sponsored by local law firm Hunter Maclean. Schaengold discussed the local impact of the reform bill.

The House bill will make positive steps toward addressing several major problems, according to Schaengold, including prohibiting denial of coverage for pre-existing conditions and eliminating annual caps on care, as well as improving transparency and dramatically reducing the number of uninsured Americans.

The measures in both the House and Senate will fall short of covering every American, but the House bill will cover about 96 percent of the population, while the Senate version insures 95 percent. Both versions will still leave millions without health insurance though.

However, Schaengold pointed out that because of the bill's size, a lot of details are still being sorted out. "It's so complex," he tells the audience, "no one is sure whether some issues have been addressed."

H.R. 3692, as passed by the House, is far from perfect.

Schaengold explained that while increasing the number of citizens with health insurance is a step in the right direction, there is a larger underlying issue of available care.

"Who is going to take care of this new group of insured citizens?" He asks.

While H.R. 3692 currently comes with a trillion dollar price tag, there have been no provisions made for increasing the number of resident doctors or primary care facilities, which could mean that emergency rooms and doctors' offices, already stretched beyond capacity, will face even longer lines of patients seeking treatment.

According to information from the Georgia Association for Primary Healthcare almost half counties in the state already "do not have an adequate number of physicians to meet basic healthcare needs."

The GAPHC represents a network of community health centers across the state -Curtis V. Cooper Community Health Center and Union Mission are the two examples locally - that offer a diverse range of services, including health screenings, dental care and pre-natal care, to name a few.

Although the CHCs have been largely absent from the healthcare reform debate, the Health Resources and Services Administration did receive two billion dollars from the American Recovery and Reinvestment Act, with funds dedicated to building new health center sites, increasing services at existing sites as well as offsetting costs for centers with spikes in uninsured population.

CHC facilities have been on the frontlines of caring for the medically underserved, and according to the Rollup Report for Georgia, in 2006, over 50 percent of CHC patients in the state were living at or below the poverty line, and 45 percent were uninsured.

An estimated 40 percent of the nation's total healthcare spending is "waste" - money not spent on directly treating disease - like systemic inefficiency, fraud and individual behaviors such as smoking and obesity, Schaengold explained last week. One important component of wasteful spending stems from misuse of emergency rooms - particularly by uninsured patients who use the ER for primary care.

According to the GAPHC, one in three Georgians have no regular source of care, such as a family doctor.

The CHCs help offset that spending by providing less costly care, particularly for the uninsured. In 2004, the most recent data on the GAPHC website, CHCs served 110,000 uninsured patients in the state, saving millions dollars by reducing unnecessary emergency room visits. They also help larger medical centers reduce charity care and bad debt from uninsured patients who default on medical bills.

While getting health insurance for a larger percentage of Americans is an important first step in improving healthcare across the nation, Shaengold expresses concern the bill would "not solve the access issue."

"It is a great thing to have more people insured," he explains, "but it's not enough to get an insurance card."

To further illustrate the point, he uses the example set by the state of Massachusetts, who passed a statewide healthcare mandate in 2006. Although 96 percent of the state's population has been insured, according to Schaengold, their primary care facilities are overwhelmed and the cost of the program has doubled.

However, a study conducted by the Urban Institute, titled "Update on Health Reform in Massachusetts," which was published earlier this year found that the state's program had increased the number of residents with regular healthcare providers, the number of residents who'd been to the dentist in the past year, and decreased the number of families who did not receive care because of costs.

The reform bill still has a long way to go. A version must pass the Senate, and then the House and Senate versions must be reconciled before seeking final approval.

Last week, Republican Senator Johnny Isakson told a crowd gathered for a state GOP fundraiser in Atlanta that the healthcare reform debate in the Senate would be "protracted," and could require another "six to eight weeks of debate" according to a report from Atlanta Journal Constitution blogger Jim Galloway.

Congressman Barrow writes, "this last round is just that - just one more round in an ongoing process...I'm confident that we can get something better."

Time, apparently, will tell.