Medicinal purposes - Health care law expert sees value of reforms

Attorney David Rogers says Affordable Care Act is difficult

to grasp

By Paul Janczewski

Legal News

The Affordable Care Act can be described in 25 words or less, but to fully understand it might require reading 250 pages. Or more.

"Actually, the link to the statute itself comes up to 985 pages," said David Rogers. "So, it's a lot of reading."

Rogers knows of what he speaks. A shareholder and founder of the Farmington Hills law firm of Rogers Mantese & Associates, Rogers specializes on representing health care providers and associated professionals in all legal health care related matters.

Before entering into this field of practice, Rogers, 61, used his undergraduate degree in business and accounting to forge a career as a regional administrator and controller for outpatient facilities owned by a large national health care company. Since graduating from Wayne State University Law School in 1982, Rogers has been recognized for his expertise in the field, served on various state bar association boards related to the field, and written scores of articles on the subject.

"All I've really done is health care law since the mid-1980s," he said. "I didn't really go to law school intending to become a health care lawyer. But I started getting a few health care related clients, and one thing led to another. I understood the industry, so I got more clients, and soon, I was doing all health care law."

Back then, he said, few attorneys were labeled as health care specialists. Now, with the Affordable Care Act, more are sure to follow.

The Patient Protection and Affordable Care Act is known by several names, some flattering, and at least one, intended as a knock on President Barack Obama, whose efforts made it the law of the land in 2010.

No matter what it's called, the Affordable Care Act will play out over the course of the next decade as portions of it ease into effect, according to Rogers. But the complexities of it will make solving a Rubik's Cube look like child's play. Who really understands the entirety of it?

"Plenty of people in the health care industry are still in the dark, too," Rogers said.

But he is a believer that the way we handled "all the moving parts" of health care needed a change.

"It's been something people have talked about for many years--how do we provide health care for those who can't afford it," he said.

Before the act, he said, we used the most expensive method of providing services. If people needed care, and had no coverage, they went to a tax-exempt, nonprofit hospital that was required to take in everyone regardless of ability to pay. That method, of course, did not spread the risk around, according to Rogers.

The act requires everyone to become insured, at the risk of financial penalty to those who do not. And therein lies the rub to many who oppose the act. Rogers said other countries have some form of health care, "but there's not a country I could point to and say that's a model we should follow."

Like it or not, the Affordable Care Act is here to stay after the U.S. Supreme Court upheld its constitutionality last June.

And like many, Rogers can't break down the act in terms everyone understands.

"I can tell you that there are different parts of it that will do different things," he said.

Aspects of it deal with regulating kinds of coverage available to people through various coverage plans, covering children on their parents' plan until age 26, and dealing with pre-existing conditions.

Some portions of the act went into effect immediately, while others have deadlines in 2013 and beyond. It will affect insurance premiums, doctors and physician groups, hospitals, insurance companies, and the entire array of fields and people associated with every aspect of health care. It is the most significant and comprehensive overhaul of America's health care system since 1965, when Medicare and Medicaid came into existence.

And anything that aims to decrease the number of uninsured people while reducing the overall costs of health care will take time, money, and a good deal of compromise, according to Rogers.

One factor that already has caused some concern is the health insurance exchanges. While more than a dozen states have established their own, other states are letting the federal government determine those, Michigan being one. Rogers said that part of the act will address the cost of premiums and the availability of coverage.

"It's not like we won't have a health insurance exchange, it'll be one that's a cookie-cutter kind that the federal government designs because Michigan didn't design its own," he said. "And it seems to me we should be designing our own, and not looking to Washington."

In the future, he believes Michigan will adopt its own health insurance exchange, and perhaps other states will follow suit.

"For a lot of issues, states will know themselves better than the federal government does, and no matter what state it is, you're probably better off designing one that fits you," Rogers said.

Down the road, the act will impact doctors, consumers, health care professionals, insurance companies, health care facilities, hospitals, nursing facilities and businesses, all of which will be required to make some choices.

"Not only are they affected individually, but their inter-relationships are affected greatly," he said.

With health care costs rising, these entities will develop new ways of grouping and working together to provide products that will resemble one-stop shopping centers for a vast array of health services, Rogers said.

"Now those are like skeletons, with no meat on it, but over time, it will develop," he said. "But you'll see providers all working together to provide the whole spectrum of services."

He said that is taking shape now in the form of an "organized system of care" or OSC. Those have been in use for several years and are designed to encourage primary care providers to share information, thereby avoiding duplication of services such as X-rays and MRIs.

While the act may sound good in theory, can it really work?

"Sure," Rogers said. "It will take time, and there will be some bumps in the road, like with anything else. It's not easy, it's complicated, it's expensive, but I'm convinced it can work.

"Uninsured people would be able to get insurance, in some cases with help from the government, and I think that's a very important thing," Rogers said.

To have insurance, even by being given the "incentive" to get it or face a penalty, will mean more people are buying policies, spreading the costs around, as opposed to just showing up at a hospital for free services. He said it should mean lower costs in the long run and a more efficient use of health care services.

Some consumers will buy the "Cadillac" of coverages, while others will purchase a less expensive plan with fewer bells and whistles. More competition should make prices affordable, Rogers said. You may have limited choices, such as what doctor or hospital you go to, but the savings in cost should offset any negatives, according to Rogers.

And since President Obama was re-elected to a second term in office, Rogers said he would be surprised to see the Affordable Care Act overturned.

"I think it's possible there can be some tweaks here and there, because like any complicated matter like this, you might see some things not work as planned," Rogers said. "With an act this complex, with so many moveable parts, it's almost a given that it will have to undergo changes in future, but the core of it would not be changed substantially, not the underlying concepts, but only in the implementation of the details."

Rogers said it is a story to-be-continued, harkening back to all the naysayers who decried the creation of Medicare and Medicaid.

"Some thought it was a disaster and would ruin the country and health care. But just the opposite occurred. It's become the pace setter, the best organized at carrying out its job, much more so than private insurance," Rogers said. "Some may not think that way, but that's what I've seen."

Published: Thu, Jan 31, 2013

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