by Sabrina Salas Matanane

Guam - In front of a packed room filled with members of the Guam Medical Association and other members of the island community, discussion went from Obamacare to TakeCare. The GMA organized last night's forum and panel discussion to discuss the recent Supreme Court ruling on the Patient Affordability Care Act (aka, Obamacare) and its impact on Guam.

The governor's chief policy advisor Arthur Clark spoke on Governor Eddie Calvo's behalf, saying he supports provisions such as extended coverage to dependents up to the age of 26 and coverage on preexisting conditions, but"The controversy starts with the individual mandate the health insurance exchange the tax credits and Medicaid. The jury is out on whether some of these things apply to Guam; if they did we need to be prepared for massive cuts in government or tax increase that our struggling people already cannot afford. If they don't we need to ask our federal government why they created a national federal medical reform system that leaves the territories behind."

Clark said there's a clear injustice done to territories, citing for example currently Guam is matching 45% of what the federal government gives us in Medicaid funding unlike in states with similar poverty levels as Guam like West Virginia, Texas, and Mississippi, which only match 20% of the federal contribution.

Clark said, "What makes us different? With the passage of Obamacare the federal government will pay 100 percent of Medicaid costs for every single state that opts in for 3 years. And the qualifications for Medicaid rises for those American at 100 percent of the national poverty level to 133 percent. That means millions more will have access to Medicaid. That all sounds really good except Guam and the territories won't get that 100 percent gift. As a matter of fact our matching requirement will remain at 45 percent until the year 2019. No one knows what will happen after that. As for the states that will get 100 percent for 3 years, they will only end up matching 10 percent after that. There's so many unanswered questions."

Questions That Even Congresswoman Madeleine Bordallo's Guam District Office director Joaquin Perez is seeking answers to. "One of our concerns is that because of the increase in the poverty level the federal poverty level. Medicaid is going to be the largest insurance policy on this island. And you're going to have a good portion of the population migrate over to Medicaid. If that happens and you still have that 45 percent match requirement the government cannot afford it. We have a situation now that we get $12 million in Medicaid and we can't come up with the match, so a lot of that money a lot of the Medicaid appropriation for Guam is actually returned to the federal coffers. And we're concerned that the same thing might happen or will happen when this comes into affect."

One of the other big concerns raised last night related to medical loss ratios as part of Obamacare health insurance companies are required to pay rebates to subscribers if they don't meet MLR's and spend at least 85% on medical costs. Based on filings with the Department of Revenue & Taxation, SelectCare will pay $11.9 million in rebates while Staywell will have to pay $3.1 million by August 1. TakeCare's 30,000 subscribers on the other hand won't be getting a single penny in rebates. Instead, stockholders of the company will be splitting $15.2 million.

According to 2011 audited financial statements the money was paid to stockholders of the company despite unpaid claims for the year increasing to $11 million and total liabilities increasing to $19.7 million. GMA president Dr. Thomas Shieh said, "The question is how can a company allow themselves take in $15 million in profit yet have that much in unpaid claims why not just pay that claim and cut that profit down to $4 million rather than having $11 million unpaid?" TakeCare's Jeff Larsen said, "Well again I'm not going to comment on the details of the $15 million but the end result is this we all have claims that we adjudicate some of those claims require research follow up so on and so forth so we do again comply with prompt payment laws as do other insurers on this panel and stateside and when those claims are due to be paid and provided their claim claims for payment they will get paid."

As we reported the Legislature, Congresswoman's Office and Rev & Tax are looking into whether TakeCare was able to avoid paying the rebates by being placed under a limited liability company, Veiovis. Shieh said, "Whether or not this is a loophole or its not a loophole more power to TakeCare. I mean if it's legal then more power to you. But I think the question here why are the premiums paid to TakeCare going to this medical travel company and not to providing care? Again, Jeff I'm gong to leave it up to you - you can run with it." Larsen said, "Well again the purpose of the forum I'm, not sure whether TakeCare's business model was the appropriate model so I'm not going to talk about Veiovis in particular but I do want to say Veiovis was created well before MLR's or Obamacare was ever in place actually 2009 was when Veiovis was created."

According to Veiovis' website, it lists TakeCare CEO and president Joseph Husslein as its founder and visionary, adding that in 2009 Husslein proudly announced the premiere of Veivois Global Access a medical travel company that is built on TakeCare Insurance's successful model for overseas medical care and coordination. But we should note according to documents filed with DRT that it wasn't until December last year that TakeCare was officially moved under Veiovis.

Shieh said, "Does Veiovis employ FHP physicians, nurses administrator under Veiovis and TakeCare?" Larsen said, "Again, I don't want to get into much detail because I don't think that's the point of the forum but the point of whose employee by Veiovis or TakeCare, Veiovis employees are medical professionals in some cases and they are also responsible for care coordination. There's talk of a loophole. The loophole is the fact when you look at how the MLR calculation is made it allows for direct patient care to be included in the numerator and so because Kaiser, Geisinger and others have their own clinics and hospitals those are all admittable assets or admittable expenses under the medical loss ratio."

What wasn't asked last night was had TakeCare not been moved under Veovis at the end of last year would it have been required to pay rebates. Its an issue that's currently under investigation.

KUAM will be broadcasting the Guam Medical Association this Saturday at 8pm on Local 2 and then again on Sunday on the same channel at 7pm.