TAHLEQUAH — The U.S. Supreme Court has upheld the federal Patient Protection and Affordable Care Act, meaning approximately 200,000 Oklahomans who did not have health insurance will gain access through either Medicare and/or Medicaid.

Under the new law, co-pays for preventive care will be abolished. Theoretically, this would encourage people who previously couldn’t afford doctor visits to seek them, thus allowing doctors to diagnose illnesses early – before they become prohibitively costly to treat.

Given the potential influx of individuals covered under the Medicare and Medicaid, some doctors believe charging a nominal co-pay or limiting visits for minor injuries could ease the immediate stress on doctor’s offices and hospitals.

But mention the word “rationing” in the same breath with health care, and many people fear they won’t get critical treatment, or will have to wait months for life-saving procedures and screenings.

Dr. Paul Hobbs, M.D., of Tahlequah Medical Group, believes preventive health care is still an important part of everyone’s health plan.

“I don’t believe that in towns like Tahlequah, and with partnerships like Tahlequah City Hospital, that patients will not get the care they seek and deserve. Statistics show patients getting the preventive care they need – such as mammograms, prostate screenings, colonoscopies, etc. – will continue to see an improved quality of life as early detection of illnesses are caught. TCH has always been extremely responsive to any emergency situation through its emergency room, and I am sure it will continue to do so.”

Dr. Doug Cox is an emergency room physician at Integris Grove General Hospital. He is also District 5 state representative for Mayes and Delaware counties, and is a Republican. Cox has suggested reducing or eliminating co-pays would only work if controls are placed on the number of doctor visits, preventive or otherwise.

“I fear that not having a co-pay could result in overuse of the system,” said Cox. “People tend to go to the doctor when it’s free for minor things they could handle at home or are self-limited – common colds, minor rashes, minor sprains, bumps and bruises, etc. I see it all the time.”

Cox knows Americans fear “rationing” when it comes to health care.

“We are used to instant access and instant service,” said Cox. “I do not think the PPACA will result in true rationing. What it may do is result in a wait to have non-emergent procedures. I do not call this rationing; many people do.”

Cox is concerned that an additional 200,000 Oklahomans gaining free access to health care could clog the system, and suggests charging a reduced co-pay.

“A co-pay of $5, less than [the cost] of many cigarettes, would amazingly cut down on the number of frivolous physician visits,” said Cox. “And yet, I do not feel that $5 would be high enough to discourage access for preventive care, or prevent those who are truly in need of urgent care from seeking access. Therefore, I feel it would have no ill effect on public health. I really like the stress on preventive health, but would implement the $5 co-pay.”

Sen. Jim Wilson, D-Tahlequah, agrees that a $5 co-pay, or even a $20 co-pay, shouldn’t prohibit people from seeking preventive care. He said since he is a good 10 years older than Cox, he remembers the wild speculation when Medicare was introduced.

“When we passed Medicare in 1965 and it went into effect in ‘66, we had the same arguments,” said Wilson. “People were saying doctors and hospitals would be inundated with people seeking care. [Those in the medical community] were all braced for an onslaught. People don’t come sit in the doctor’s office for the fun of it. It just turns out that people don’t access the system unless they need to.”

The U.S. spends about 17 percent of its Gross Domestic Product on health care. Cox said he has researched the situation, and has found many other countries have better health outcomes and spend only 9 percent of their GDPs on health care.

“[In conducting this research], I have noted they have a few things in common,” said Cox. “First, they have universal coverage, which spreads the expense over the entire population. Non-elective procedures – hernias, elective knee/hip replacements, etc. – take a back seat to urgent procedures, which may result in a waiting period from three to 12 months. Americans have to ask themselves if they are willing to do this as part of a plan to help control costs. Other countries also place an emphasis on preventive medicine, and emphasize personal responsibility. [If you] smoke, you don’t get a lung transplant; if you drink, you don’t get a liver transplant; if you weigh 400 pounds, you don’t get a new knee. Again, some Americans consider that rationing; others call it trying to get the best use of limited resources.”

The Oklahoma Health Care Authority has estimated that, in 2016, when the state is set to take over 10 percent of PPACA costs, the amount will be $26.7 million, and would increase to $32.6 million in 2018, $38.8 million in 2019, and $56.6 million in 2020.

“I feel this is a number we can afford,” said Cox. “Some studies – including those by the Robert Wood Johnson Foundation and Urban Institute – estimate there would be an additional 16,397 jobs created in Oklahoma, which would generate $495 million in payroll dollars. That would generate $52 million in state income from personal tax revenue. That would offset the cost of the program.”

Wilson agreed, saying that by adding the 200,000 Oklahomans to the system, the state would be cutting distributed costs to those who already have insurance. He, too, has done the math, and said between the increased employment and payroll, the state will actually make money.

“Right now, it costs $983 per year, per insured person, to pay for those who are not paying for health care,” said Wilson. “If Oklahoma has a population of 3.7 million people, then $3.5 billion would no longer be cost-shifted. It would save individuals that $983 per year they’re paying to care for others.”

Wilson also pointed out many state legislators have made it clear they want no part of federal money.

“The people who say, ‘Well, if you take federal money, it’s still taxpayer money’ don’t understand the state currently receives $1.35 for every dollar it sends to the federal government,” Wilson said. “It’s insane to say we don’t want federal dollars, and if we want to be esoteric about it, let’s close Tinker AFB. It’s bogus to use that argument. The feds are going to spend the money, and they may as well spend it here in Oklahoma. There are people out there who seem to think we’re better off depriving people of health care. We can afford to give everybody health care. We know we can, because other countries do it.”

Cox echoed Wilson’s statements about cost-shifting.

“We have health care for everyone already,” said Cox. “Many access it and do not pay. The cost of uncompensated health care is presently cost-shifted to those of us who work and have insurance or self-pay premiums. We are paying for the deadbeats. I like the PPACA, because it penalizes those who do not have insurance with a monetary penalty. At least they are going to pay for not being responsible. That’s why I’m not so sure why so many of my [Republican] colleagues are so adamantly opposed to the act; [penalty for irresponsibility] is a pretty Republican idea. It is estimated PPACA would result in a reduction of $324 million in uncompensated care for providers, which cost-shifts to the insured.”

What you said

The Daily Press conducted an online poll of its readers, asking whether restrictions on medical care should be placed on people once they are required to purchase insurance, or are covered in a pool through expanded Medicare and/or Medicaid, but no longer have to pay co-pays for preventive medical care. Of 84 respondents, 60 percent, or 50 voters, said no restrictions of any type should be placed on anyone for any treatment.

Fifteen percent, or 13 voters, said restrictions should be placed on everyone for non-essential or unproven treatments.

Fourteen percent, or 12 voters, said restrictions should be placed on those who are on Medicare and/or Medicaid for the number of times they can see a doctor for non-essential care, non-proven treatments, or due to triage. The latter option offered an example – that people in their 90s wouldn’t necessarily get government-paid hip replacements.

Eleven percent, or nine voters, indicated they were undecided on the issue.

Tell us about it

The Daily Press is posting regular polls to augment its ongoing series on the new healthcare law. Check back regularly at www.tahlequahdailypress and weigh in on our home page.

What’s next

The third in the ongoing series will take a look at Indian Health Services and how PPACA will affect medical care for citizens of American Indian tribes. To read the first in the series, visit http://tinyurl.com/cabtssb