EDITORIAL: Take care what you wish for

SOMETHING WAS UP. Columbia Memorial Hospital, the largest private employer in the county, beckoned the media to an “availability” with some state politicians. Gotta be news, right?

So up we go to the third floor lounge, where the VIPs gather for big events, and sure enough, there were two state senators, except that neither of them currently represents this county, and the conversation starts along the lines of a reporter asking, What are we here to talk about? and the senators responding genially, What do you want to talk about?

Summer can be a slow time for news, but this interview promised to be less exciting than reading the side of a Wheaties box. And yet while neither hospital officials nor the politicians volunteered to broach the subject, the timing suggested the topic foremost on everybody’s mind was the recent Supreme Court decision upholding the federal Affordable Care Act, now commonly known by supporters and critics alike as Obamacare.

In fairness, the hospital and the office of Senator Roy McDonald (R-43rd) had made it clear in advance that Mr. McDonald, chairman of the state Senate Committee on Mental Health and Developmental Disabilities had invited one of the Senate’s senior GOP leaders, Kemp Hannon (6th) of Long Island, chairman of the Committee on Health, to talk privately with hospital staff about unspecified topics. Mr. McDonald, whose district lies north of here, is running for reelection this fall in a newly redrawn district that includes all of Columbia County, so this was partly an exercise in the power of incumbency. He knows the next state legislature will play a key role in shaping the way the national healthcare law works in this state and how it affects the future of an independent local hospital like Columbia Memorial.

One of the central provisions of the Affordable Care Act is the requirement that most people acquire health insurance either through a government program like Medicare or Medicaid, through their work or by purchasing it themselves. To assist people buying their own insurance, each state has to have a health insurance exchange, which finds uninsured people the least expensive policy that meets federal requirements.

The state Senate did not adopt legislation creating a state exchange in this session, so Governor Cuomo did it himself by executive order. The slim GOP majority in Senate appeared relieved to let the governor handle the whole matter. Asked about the specifics of exchanges last week in Hudson, Mr. Hannon said that the problem wasn’t about the politics of creating the exchange; he attributed the Senate’s foot dragging to the complex “mechanics.” He’s right that the issues are complicated. But if the majority believes it’s too complicated–or too politically risky–to do, then it’s time to let someone else try.

Senator Hannon had good reason to dodge this question. It’s a skill other Republicans in the state may have to cultivate this fall. This state has already enacted several popular measures that are part of the national law, like allowing adult children to remain on their parents’ health insurance policies and prohibiting insurance companies from denying coverage because of some pre-existing conditions. It’s tough to win state office here running against government healthcare.

A relatively high number of New Yorkers have some sort of health insurance compared to other states, and still it cost Columbia Memorial Hospital $9 million last year to treat people who have no coverage and can’t pay their bills. The Affordable Care law could remove that financial burden on the hospital but it could also add new ones, with demands for reductions in the overall cost of care and looming cost increases that may follow the expansion of Medicaid.

Whatever the senators and hospital staff discussed last week, the conversation itself is a measure of the change we are all about to experience in the patchwork we call a healthcare system. Obamacare resisters can snarl all they want, but at the places where care is actually delivered, politicians and caregivers know the time has come to get down to work implementing the law.

It’s possible, even likely, that Obamacare will prove too complex and cumbersome to deliver what’s been promised. But thoughtful politicians on both sides of the healthcare debate know by now that Obamacare’s failure won’t lead the public to give up the gains we’ve made. On the contrary, it would only increase public support for a simpler national healthcare system that some call Medicare for everyone.



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