.floatimg-left-hort { float:left; } .floatimg-left-caption-hort { float:left; margin-bottom:10px; width:300px; margin-right:10px; clear:left;} .floatimg-left-vert { float:left; margin-top:10px; margin-right:15px; width:200px;} .floatimg-left-caption-vert { float:left; margin-right:10px; margin-bottom:10px; font-size: 12px; width:200px;} .floatimg-right-hort { float:right; margin-top:10px; margin-left:10px; margin-bottom:10px; width: 300px;} .floatimg-right-caption-hort { float:left; margin-right:10px; margin-bottom:10px; width: 300px; font-size: 12px; } .floatimg-right-vert { float:right; margin-top:10px; margin-left:10px; margin-bottom:10px; width: 200px;} .floatimg-right-caption-vert { float:left; margin-right:10px; margin-bottom:10px; width: 200px; font-size: 12px; } .floatimgright-sidebar { float:right; margin-top:10px; margin-left:10px; margin-bottom:10px; width: 200px; border-top-style: double; border-top-color: black; border-bottom-style: double; border-bottom-color: black;} .floatimgright-sidebar p { line-height: 115%; text-indent: 10px; } .floatimgright-sidebar h4 { font-variant:small-caps; } .pullquote { float:right; margin-top:10px; margin-left:10px; margin-bottom:10px; width: 150px; background: url(http://www.dmbusinessdaily.com/DAILY/editorial/extras/closequote.gif) no-repeat bottom right !important ; line-height: 150%; font-size: 125%; border-top: 1px solid; border-bottom: 1px solid;} .floatvidleft { float:left; margin-bottom:10px; width:325px; margin-right:10px; clear:left;} .floatvidright { float:right; margin-bottom:10px; width:325px; margin-right:10px; clear:left;} How do Iowa physicians feel about the health-care bill that President Barack Obama signed into law last week?

“Overall, I would say most of our Republican doctors didn’t like the bill, and that most of our doctors who are Democrats were happy with the bill,” said Dr. Michael Kitchell, an Ames neurologist and president of the Iowa Medical Society.

Despite its political divisiveness, even among doctors, the legislation goes a long way toward providing better access to health care for millions of uninsured Americans, Kitchell said during a “Power Breakfast” panel discussion on health care last week.

Sponsored by the Business Record, the event’s panel of experts also included Jim Swift, chairman and CEO of insurance broker Holmes Murphy & Associates Inc., Kirk Norris, president and CEO of the Iowa Hospital Association, and Joel Duncan, president and CEO of Merit Resources Inc., which manages employee benefits for primarily small businesses.

Moderated by Loretta Sieman, a consultant and former West Des Moines city councilwoman, the breakfast event took place, coincidentally, just hours before Obama signed the Patient Protection and Affordable Care Act into law.

The panelists on the insurance end of the table, Duncan and Swift, said they were largely disappointed with the measure for what they said was a failure to adequately address the needs of small businesses and rapidly escalating health-care costs.

The medical panelists, Kitchell and Norris, each spent more time discussing favorable provisions of the bill, namely initiatives to reduce the number of uninsured individuals and address long-time disparities in Medicare and Medicaid payments to Iowa doctors and hospitals compared with more densely populated areas of the country.

With an estimated price tag of $940 billion during the next 10 years, the health-care overhaul is expected to expand coverage to an additional 32 million Americans by 2019, through an expansion of the Medicaid program and by providing subsidies to enable more people to access private health-care plans. The expanded coverage will be funded through a combination of reduced Medicare payments to hospitals and new fees or taxes on insurers, pharmaceutical and medical device manufacturers and individuals earning more than $200,000 a year.

Some of the legislation’s provisions become effective this year, among them tax credits for small businesses that offer health insurance and added funding for high-risk insurance plans for people who can’t get insurance because of pre-existing conditions. Other provisions, such as online insurance exchanges through which individuals can shop for coverage, don’t go into effect until 2014. In that year, businesses with more than 50 employees will begin facing fines if they do not offer health coverage, and individuals will be required to purchase insurance or be penalized.

Swift, whose company generates about one-quarter of its revenues from health insurance sales, said the bill will do nothing to slow the increase in health-care costs, which is a major concern of his clients.

“On balance, I’d have to say that I’m displeased, because I think costs are going to continue to spiral upward,” said Swift, who characterized a broken health-care system as the problem, not a need for reform in health insurance.

“It really comes down to that you either need to get healthy, or make different choices in how you use health care,” he said. “It seems logical that the doctors need to step forward and make some of these decisions (related to the care they’re recommending for patients).”

Eliminating exclusions that insurance companies can now make for pre-existing conditions is bound to drive up premiums because it’s going to cost insurers more to pay for those individuals’ health conditions, Swift said. “And I don’t think the fines (for not having insurance) are enough. So you may have the younger, healthier population opt out. So our sense is that (the legislation) will drive costs up.”

However, the new law does begin to address the geographic disparity in Medicare and Medicaid reimbursements that Iowa hospitals receive compared with the same procedures performed elsewhere in the country, Kitchell said.

There is evidence that Iowa health-care providers are providing care in a more cost-effective manner than in other parts of the country as well, he said. For instance, the average annual cost per patient in Miami is $16,300, compared with $6,300 in Iowa.

“If you believe those people in Miami are $10,000 sicker than people here who are generally older, I have a good stimulus package to sell you,” Kitchell joked. “The key is to begin rewarding the value of care that’s provided. This bill actually goes forward with paying for value. We’ve got to incent our doctors to give more cost-effective care, not more expensive care.”

The legislation doesn’t do enough for small businesses, said Merit Resources’ Duncan, whose company provides payroll and benefits administration for approximately 200 employers.

“The one sentiment that our clients have is that these (health-related) cost increases cannot be sustained,” he said. “Nothing in this bill does anything to lower costs today during the economic crisis.” Meanwhile, “we are looking at what we can do to curb costs until 2014 when the health insurance exchanges go into effect,” he said.

In many cases, businesses have shifted higher health insurance costs to their employees by taking steps such as increasing the deductible amounts workers must pay, Swift said. However, “we’re not seeing a great number shift away from providing coverage. We’re seeing them manage the cost internally. We’re facing a pretty significant increase at Holmes Murphy,” he added.

According to a 2009 survey of Iowa employers by David P. Lind & Associates, 53 percent of companies offered health insurance to their employees, and that study indicates that businesses have not been dropping coverage, said Lind, who attended the forum.

Norris said that providing care more effectively will help to drive down costs and will be a key benefit of reform.

“We’ve got to get away from the notion that somehow this cost isn’t in the system today,” he said. “The folks that we’re not insuring, that cost is in the system today; it shows up in the emergency rooms, and we’re paying for it through our insurance premiums. The question is, how do we want to pay for that care?

“A lot of employers are probably saying, ‘I need a bigger tax credit,’ while a lot of struggling families are saying, ‘I need a bigger subsidy,'” Norris said. “Virtually nobody got everything that they wanted out of this legislation, so maybe it’s a good attempt at financing the cost that exists within the system today.”