Although President Obama's healthcare law is gaining acceptance http://gma.yahoo.com/health-reform-law-gaining-wider-acceptance-poll-140405876.html, it is still a hotly contested issue and no doubt will remain so through the 2012 election. As the courts and politicians sort this all out, millions of Americans are caught in healthcare limbo, many of them members of vulnerable populations. The January 29th article from the Rapid City Journal (below) is just one example. At least there are some healthcare professionals, like Kaiser Permanente, that are trying to bridge the gap. http://www.prnewswire.com/news-releases/kaiser-permanente-leads-nation-in-nine-effectiveness-of-care-measures-for-medicare-136678278.html
State taking wait-and-see approach to healthcare reform
For a time after Congress passed healthcare reform in March 2010, Auralee Nickels thought she might finally get health insurance despite a pre-existing medical condition.
As the months dragged on, "I kinda just gave up on it," she said.
When the Hermosa woman learned last week that a study shows South Dakota to be one of 15 states with very little progress toward implementing the Affordable Care Act, she felt frustrated all over again.
"It's crazy that we have more concern about vehicle insurance in this state than health insurance," she said. "I would gladly pay a higher premium knowing that I'm more in need of it than the guy next to me. I just can't get any."
Earlier this month, Gov. Dennis Daugaard announced that the state would not move forward on creating health insurance exchanges -- one of the mandates of the Affordable Care Act -- until the U.S. Supreme Court rules on the current lawsuit.
South Dakota is one of 26 states involved in the suit, which argues that portions of the ACA are unconstitutional. The Supreme Court will begin hearing arguments beginning in March.
Daugaard said he doesn't want to "waste time and money" on creating an exchange if the act is eventually overturned.
Exchanges are regulated markets that bring together insurance providers and those in need of insurance. The ACA requires states to show progress toward creating exchanges by January 2013. Implementation is targeted for 2014.
If states do not develop their own exchange, the federal government can create and operate exchanges for them.
That's something Daugaard never wants to see.
"I don't want to be forced," he said.
Yet if states don't meet the deadline, that's exactly what could happen, according to Lorez Meinhold with the Colorado governor's office. In the new study by Urban Institute titled "State Progress Toward Health Reform Implementation," Colorado was ranked in Group 1, which means it's a state that has made sufficient progress toward implementing an exchange program.
She believes that states that don't meet the deadlines could get a federal plan instead.
"Our understanding right now ... is by that Jan. 1 (2013) deadline you have to show progress," Meinhold said.
But Rep. Lance Russell, R-Hot Springs, said the state has nothing to worry about.
Russell said problems exist in the wording of the reform legislation that would prevent the federal government from going into states and setting up federal exchanges. As a result, he believes Daugaard's plan to wait is a good one.
"I think it's prudent on his part to hold back on the exchange," he said.
Tony Venhuizen, a senior adviser to Daugaard, said too much is unknown about the healthcare reform act at this point, including what the true deadlines are.
"One of the things about healthcare reform has been that a lot of these deadlines have been subject to change. There's a lot of uncertainty about that. That's one of the reasons we've elected not to go forward at this point," he said.
South Dakota certainly isn't alone in its watch-and-wait approach. According to the Urban Institute study, 14 other states fall into Group 3, indicating that they have not passed any legislation to allow for exchanges, nor have they "demonstrated significant interest in doing so."
In addition to South Dakota, neighbors North Dakota, Wyoming and Montana fall into the Group 3 category.
Meinhold said Colorado, a Group 1 state, has created a non-profit organization and its board has been meeting twice a month since July. The group obtained an initial planning grant -- available to all states -- which allowed it to do technology planning, hire an interim director, develop a board and begin addressing legal matters that surround exchanges.
Meinhold said the process of establishing exchanges has proven to be complex.
While she recognizes that many states like South Dakota are "waiting to see what happens," she's glad Colorado is not one of them.
"We feel pretty crunched even by the timelines," she said. "Even as a state that's made progress, we're worried about making the deadlines."
Daugaard said it's inaccurate to portray South Dakota as a state that has done nothing. With initial grant money, it did a survey to identify the number of uninsured in South Dakota. He said the numbers appear to be about 9 percent. The Kaiser Family Foundation puts the number at 13 percent.
"We've done some planning. We've applied for a grant," he said.
Even if the ACA is upheld, Daugaard believes the state can safely meet the requirements by deadline.
"South Dakota is a very nimble state," he said. "We can get things done much more quickly than most places."
Venhuizen said earlier in the week, however, that, "There would have to be pretty extensive legislation brought to create an exchange."
The debate on when and if South Dakota will enact healthcare reform plays a peripheral role in Nickel's day-to-day life. The 35-year-old was diagnosed as a child with a genetic condition that hinders her liver's ability to clear bad cholesterol from the blood.
Her "pre-existing condition" has lead to two heart attacks - one at the age of 32. She waited three days before seeing a doctor because she didn't have insurance.
Nickels recently paid off her doctor's bills and is debt free for the first time in years. She isn't confident it will last. "I'm one incident from being right back where I was," she said.
Nickels has been told it would be best to see a cardiologist every six months for her condition, but does so only once a year due to the cost constraints. She pays cash for each visit. She gets her medication donated by the manufacturer.
She has purchased insurance in the past, but companies require a 12-month period without a medical incident for those with pre-existing conditions before coverage kicks in. Nickels said she has never been able to reach the 12-month mark. Once, she came within three days, which essentially made the premiums she had paid for the past year a waste, she said.
Even though she has a job and a home, Nickels said the frustration with not being able to get insurance makes her feel like a "second-class citizen."
"It's not like I'm a deadbeat and don't pay my bills," she said. "It's not like I'm in a tax bracket where I need assistance in any other way. I live a pretty good life but I just can't afford healthcare and that's ridiculous."
Daugaard said he understands there are extraordinary situations. "I'm not heartless and I do know that there are people out there who fall through the cracks and yes, the state should look into that," he said. But for the most part, Daugaard said "most people are self-reliant. Most people are finding the means to obtain coverage."
And that should be the goal, he said. "We've got to, at some point in time, say adults must take care of themselves."
