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Local panel fields questions about health care act

– The onus for health care is on insurers, doctors and patients, not the White House, panelists said Thursday night at a forum on the Affordable Care Act.

“It’s not that the federal government can force an insurance company to offer a plan,” IPFW medical ethicist Abe Schwab said. “The insurance companies are in the market by choice. And so they can leave the market as they see fit.”

Asked about insurers that have canceled policies for millions of customers because the plans don’t meet coverage requirements of the health care law, Schwab said, “They wouldn’t be canceling these plans if Obamacare hadn’t come about. That’s true. But Obamacare isn’t actually forcing them to do this.”

Emergency physician Dr. Phil Wright, who formerly was medical director for insurer Physicians Health Plan of Northern Indiana, said any cancellation is “a business decision that was made by the insurance company. … Insurance companies look at it from the bottom line.”

In other words, insurers are deciding to drop coverage rather than upgrade it.

Wright, Schwab and Mary Haupert, chief executive officer of Neighborhood Health Clinics, answered questions from about 75 people gathered at First Presbyterian Church.

Although the Affordable Care Act calls for four levels of insurance premiums and coverage – known as bronze, silver, gold and platinum – Haupert and Schwab said that as far as they can tell, none of the participating providers in northeast Indiana is offering a premium plan.

Disputes over medical coverage will end up in court, Wright said.

“Medicine is complex and resists being put in a box and being quantified and being objectified,” he said. “ … It’s ultimately going to come down to how somebody interprets it.”

Or as one audience member put it, insurers consider a colonoscopy to be preventive medicine unless a polyp is discovered and removed, and then the procedure becomes treatment.

Panelists tried to quell worries about whether customers would be stuck with coverage under the Affordable Care Act. Haupert said they are eligible for refunds if they switch from government marketplace policies to Medicare or employer-provided insurance. And Schwab said individual insurance policies can be canceled by the month.

The federal insurance enrollment website,, is finally working out some of the bugs that have prevented people from applying online, Haupert noted.

“And it does work part of the time if you do have patience,” she said.

Haupert seemed more concerned that Fort Wayne is long on medical specialists and short on family practioners, gynecologists, pediatricians and internists.

“There aren’t enough” primary care physicians to provide the checkups and preventive care emphasized by the Affordable Care Act for newly insured people, she said.

Wright predicted that such patients increasingly will see nurse practitioners.