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PAGE UPDATED BY MARIA SIEVERDING OCTOBER 24, 2017.

Ripley County Board of Health celebrates 50 years of service

Wanda English Burnett
EDITOR

Ripley County Board of Health celebrated being in existence 50 years on October 17 with a ceremony and open house for the public. Harley Robinson, DVM, president of both the local board of health and the Indiana Association of Local Boards of Health, emceed the program. Various speakers talked about the success of the Ripley County Board of Health.

Harley Robinson receives an Award of Excellence Plaque WANDA ENGLISH BURNETT PHOTO
Pictured left, Harley Robinson, DVM, receives an Award of Excellence plaque from Pam Pontones, deputy state health commissioner, at the 50 year celebration of the Ripley County Health Board. Robinson serves as the president of both the local board of health and the Indiana Association of Local Boards of Health (INALBOH).

Dr. Robinson noted that the board has a futuristic approach always looking ahead to new challenges and new ideas. He told the large crowd gathered at the Ripley County Annex in Versailles that “It’s about leadership.” He believes that a healthy leadership makes it easy for those who are working together to be strong. Over the years the local health board has had different people serve.

Dr. Robinson pointed out that one original person, Ella Hisrich, was the secretary in 1967 when the board was formed. Her son, Bill Hisrich, still serves today on the board. “We’ve had a Hisrich serving for the whole time since the board was formed,” he commented. But, as people came and went serving on the board, Dr. Robinson said all of their leadership made the health board stronger as they served and gave their ideas, and those who continue to serve and network with various agencies, entities, and organizations in the county and state. The six functions of board governance were mentioned: Policy Development, Resource Stewardship, Legal Authority, Partner Engagement, Continuous Improvement, and Oversight.

County Commissioners Gary Stutler and Bob Linville were in attendance and presented a decree to the Ripley County Health Board for 50 years of service and the great strides that have been made in public health over the years. Pam Pontones, deputy state health commissioner and state epidemiologist, spoke to the crowd, thanking the local board for their dedication to public health. She noted that Ripley County in many instances is above the State percentages. One example she gave was immunizations. Ripley County ranked at 76% with the State trailing at 63%. Pre-natal care was just another example she noted where the local department rose above the state level. She commended the local board for their diligence.

Pontones presented a plaque to Dr. Robinson and the local board of health for their diligence to carry out public health affairs. It read in part, “For outstanding contributions in promoting, protecting, and providing for the health of people in Indiana for over 50 years,” and was signed by the State Health Commissioner Kirstina Box.

Another speaker, Jerry King, executive director of the Indiana Public Health Association, a board on which Dr. Robinson serves, noted that rural communities and local health departments are a great example of the importance of partnerships. He said the first health officer was Paul Revere, yes, the horse riding Paul Revere in 1799. He further stated that local health departments have evolved over the years.

David J. Welsh, MD, Ripley County’s present Health Officer, commended the people who serve in local public health roles. He said Ripley County has a great group of people who are always willing to pitch in and help. “We have people who care,” he stated. “Whenever someone is asked to do something – they do it,” he noted. He had high praise for Margaret Mary Health, who continues to be a great asset in the county.

The final speaker for the day was John Moton, standing in for Indiana’s 6th District US Congressman Luke Messer. He said, “We’re all in it (public health) together,” and let the public health officials know that Messer’s office stands ready to help if needed.

Dr. Robinson thanked those who gathered in the courthouse annex room that rarely sees a crowd so large that some people had to stand throughout the ceremony. He said he was pleased with the turnout with several State dignitaries attending, along with local people who network with public health. He recognized Milan School Superintendent Jane Rogers and South Ripley Superintendent Rob Moorhead for their commitment to public health through the schools they serve.

The celebration was a day-long event, with information tables set up in the health department area, along with a scrapbook that was compiled by Charlene Keck, registrar, that went back to 1967. Several articles from the Osgood Journal and The Versailles Republican were preserved inside the boundaries of the book.

Thinking About Health
Nibbling away at the Affordable Care Act

Trudy Lieberman
RURAL HEALTH NEWS SERVICE

As annual enrollment for Obamacare insurance approaches on November 1, the law itself and the people who have come to depend on it for health coverage are both facing an uncertain future.

President Trump’s recent executive actions affect the complicated insurance mechanics of the Affordable Care Act, and they haven’t been well explained in the news media. This column will explain how those changes affect you. Congress has tried but has not been able to “repeal and replace” the law that has brought health insurance to some 10 million Americans who buy insurance on the state shopping exchanges and about 10 million more who gained access through Medicaid expansion. The failure of Congress to pass the “repeal and replace” legislation did not mean, though, that the law would remain intact.

In mid-October President Trump’s executive action hollowed out a big chunk of the ACA, throwing insurance marketplaces into a tizzy and possibly resulting in higher prices and less coverage for many. In the end, the president’s actions may succeed in gutting the law that has divided so many Americans. To understand this, let’s take a step back. Legislators who wrote the law knew that a big reason people did not buy health insurance was cost. Most middle class families without employer coverage struggled to pay the premiums in the so-called individual market where they had to shop. Those at the bottom of the income ladder either qualified for Medicaid or did without insurance. About 44 million Americans did not have insurance when the law took effect four years ago.

The ACA tried to make it easier to buy coverage, and Congress did that in two ways. It required insurers to cover all people - sick or well - who applied for coverage in the individual market and offered two kinds of subsidies to help those with lower incomes. One comes in the form of tax credits the government advances to shoppers who buy Obamacare - compliant policies that meet certain rules and regulations, such as offering 10 essential benefits. Prescription drug coverage is one. Those subsidies are based on a family’s income and phase out when a family’s income exceeds 400 percent of the federal poverty level or about $98,000 for a family of four and $48,000 for a single person. People with lower incomes receive the largest subsidies. Those tax credit subsidies are not affected by Trump’s order.

The other subsidy is called a cost-sharing subsidy, sometimes referred to as a CSR and aimed at Americans whose incomes are at or below 250 percent of poverty, about $62,000 for a family of four and $30,000 for an individual. They reduce the amount of out-of-pocket spending for people who get them. Those who qualify pay less for the coinsurance, deductibles and copayments a policy may require. These are the subsidies on the chopping block. The president said the government will not continue funding them which means the government simply will not pay insurance companies for reducing the out-of-pocket costs to policyholders. Policyholders will still get the subsidies unless Congress changes the law. Insurers will have to swallow the losses, at least for now. If you get those subsidies, you’re not off the hook, though. Insurance companies anticipated that the president would axe the subsidies and they increased their premiums for most or all Obamacare policies, including the silver plans, the ones people must buy to receive the extra help with cost sharing.

The Congressional Budget Office just projected that premiums before the tax credits are applied would increase on average by about 20 percent. In some states average rate increases have been much higher. So who will be hurt the most by the Trump administration’s latest move which some experts argue undermines the stability of the health law?

Insurance companies have already prepared for this and have cushioned the blow to them by charging higher premiums to everyone who buys in the individual market. People with incomes under 400 percent of poverty will still receive their tax credits, which will reduce their higher premiums, and they will continue to get their CSRs. Those in the individual market who have higher incomes and receive no tax credits to lower their premiums will feel the most pain. The Kaiser Family Foundation reports that 44 percent of buyers in the Obamacare market did not qualify for tax credits. That’s almost 7 million people. “Ironically, it is these unsubsidized folks who have complained the loudest about Obamacare’s big premiums and deductibles,” says Washington D.C. insurance consultant Robert Laszewski. “They will now have even more to complain about.”

The administration wants to let them buy cheaper policies that cover far less than Obamacare insurance. In a future column I will discuss this and other moves that will further unwind the Affordable Care Act.

If you buy coverage in the individual market, how will you and your family be affected? Write to Trudy at trudy.lieberman@gmail.com.