Dr. Daniel Heinmann
HURON – If South Dakota physicians were polled as to their opinion of the controversial Affordable Care Act, they would likely be evenly split for and against.
But Dr. Daniel Heinemann of Sioux Falls, president of the South Dakota State Medical Association, also suspects individual components parsed out of the law would find more support than opposition.
“It’s really about the politics,” he said in an interview last week in Huron.
Heinemann, a board-certified family medicine physician, is the 132nd president of the association. A Dell Rapids native, he is a chief medical officer for the Sanford Health Network and Sanford Clinic.
He was in town for a meeting of the Huron District Medical Society doctors, talking about health care issues facing patients and physicians in South Dakota and the association’s advocacy issues for the upcoming legislative session.
Heinemann sees positive aspects of the law many refer to as Obamacare, such as allowing parents to keep their children on their insurance policies until age 26.
Other components cause more concern, like the Independent Payment Advisory Board. “I think physicians are concerned that it’s another government agency,” Heinemann said.
People are also concerned about the individual mandate for insurance coverage, and think it should be delayed like the small business mandate has been postponed a year.
Still, the nation has decided that health insurance is the price of admission into the system.
“If you want to be able to access the system you’ve got to have health insurance or some type of coverage,” he said.
Implementation of the Affordable Care Act will mean coverage for another 35 million people in the country.
“We know that individuals who have health insurance are healthier and live longer,” Heinemann said. “Health insurance is also key to getting appropriate preventative health care services.”
Alternatives are expensive emergency room care or delaying seeing a physician.
“I understand the pressure on small businesses,” he said. “A lot of physician practices are small businesses. But, again, this country has decided that health insurance is going to be the entry vehicle into the system, so then we need to figure this out.
“Is the Affordable Care Act perfect? No, but it’s a start,” he said.
He is encouraging physician members of the South Dakota State Medical Association to stay engaged on the issue, and share what works and what doesn’t work.
“Don’t disengage just because you don’t like the politics involved,” Heinemann said. “Really it should be about our patients and making sure that our patients have coverage and can get the services.”
Although Gov. Dennis Daugaard has voiced concerns, more citizens in South Dakota should be covered by Medicaid, he said. Medicaid expansion should be up to 138 percent of the federal poverty level.
A concern is once it’s in place, what will happen if the federal government can no longer pay its share.
“At the same time, I think we can figure out a way to get that done in South Dakota,” he said.
As the 2014 Legislature nears, physician members of the statewide association are focused on making sure there are solid immunization laws on the books.
A growing problem is violence against health care workers in clinics, hospitals and emergency rooms.
“And it’s probably a symptom of our violent society,” Heinemann said. “Health care workers are being subjected to more aggressive and violent behavior.”
But the biggest health care issue facing the state Legislature is probably whether Medicaid should be expanded, he said.
Association members have let the governor, his administration and legislators know that they are willing to sit down and talk.
“We are in the business of providing that care,” Heinemann said. “We would love to help solve and come up with some solutions for some of these problems in South Dakota.”
The approach should be to partner with legislators and the administration rather than reacting to what the other does, he said.
Heinemann and other physicians have praise for the governor’s primary care task force, and the new Frontier and Rural Medicine (FARM) program at the state’s medical school. Under the initiative, third-year medical students go out to work in communities of less than 10,000 people.
It’s been very popular, with more interested students than available slots.
South Dakota needs to continue offering incentives like FARM to encourage more physicians to set up practices in the state’s smaller communities, he said.
Financial incentives also include loan repayment, and scholarship and tuition reimbursement.
“We’re very concerned because as we add more people to the insurance roll, and you add more people to Medicaid, we have to have doctors for them,” he said.
For the complete article see the 10-13-2013 issue.
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