Cape Cod Times

Memo to Washington: Don't expect to see Cape Codders jumping with joy over the health care reform bill that seems to be emerging from Congress.

Liberal or conservative, union official or business representative, the individuals interviewed for this story fear the proposed legislation will further burden already struggling middle-class workers while barely denting runaway health care costs.

Cape businesses don't foresee big changes in their own health care policies because the national plan seems to be using the Massachusetts mandate as a model, said Wendy Northcross, CEO of the Cape Cod Chamber of Commerce.

Massachusetts health reform, passed in 2006, requires people to have health insurance or face an income tax penalty. It also increased government-subsidized programs for lower-income people, resulting in almost universal coverage.

"It certainly has expanded access to health care, but it has not helped with the approachability," Northcross said.

Some employers are facing premium increases of 20 to 50 percent, Northcross said. "The net effect is a lot of people keep their employee count a little low."

Insurers who had saved money by denying care to people with pre-existing conditions — which would be forbidden under national health reform — probably will just pass the cost on to everybody via higher premiums, said Dr. Brian O'Malley, a physician in Provincetown.

"There's no control over that," he said.

A member of Cape Care, an organization that is trying to bring a public-option insurance program to Barnstable County, O'Malley also is troubled by a lack of focus on reducing medical waste and other costs.

And he says a plan to increase coverage for poor people by expanding Medicaid programs seems poorly thought out at a time when states — which split Medicaid costs with the federal government — are financially in the red.

At the other end of the political spectrum from O'Malley, State Rep. Jeff Perry, R-Sandwich, is concerned over the rising cost of health care.

If Congress were serious about health reform it would look at streamlining medical records, tort reform and allowing people to purchase insurance across state lines to get competitive rates, Perry said.

People aren't saying their health care is bad, he said. "They're saying the cost of health care is too high."

Celia Wcislo, who works for a union that includes most of the employees at Cape Cod and Falmouth hospitals, fears that Congress will pay for health reform with a tax on insurance plans that will hurt individuals already financially stressed by rising premiums.

While the House proposes to pay for expanded coverage with an income tax surcharge on wealthier people, the Senate would put a 40 percent tax on insurance plans with premiums above $8,500 for individuals and $23,000 for family plans.

Calling this a tax on luxury plans is wrong, said Wcislo, assistant division director at 1199 SEIU.

"It's not Cadillac plans — it's expensive plans," she said. "It's not that the benefits are better."

Congress also proposes to cover the cost of expanding coverage by cutting Medicare payments to hospitals and other providers — a prospect that alarms officials at Cape Cod Healthcare, the parent company of Cape Cod and Falmouth hospitals.

Cape Cod Healthcare supports reform in general, spokesman David Reilly said in a prepared statement. But, he added, "We certainly would not be in favor of anything that exacerbates the financial struggles hospitals and doctors are currently experiencing because ultimately that hurts patients."

Parts of the health reform proposal look promising — but which parts depend on a person's political viewpoint.

Perry likes the fact the compromise does not include a public option, saying the elimination makes it a "less worse bill."

Wcislo mourns the loss of a strong public option, and O'Malley is disappointed that a single-payer system — having everybody on a Medicare-type plan — was never even considered.

But those two say they are cheered by a proposal that would allow people ages 55 to 64 the option of buying into Medicare.

"It's the only approach I can see as having any real merit," O'Malley said.

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