HEALTHCARE professionals continued to discuss the local implications of the Patient Protection and Affordable Care Act, aka Obamacare, at a conference held by the Guam Medical Association last night at the Hyatt Regency Hotel. In attendance were representatives of the four healthcare providers on Guam, government agencies and GovGuam officials.

According to the participants, interpreting what Obamacare means for Guam is difficult to do because of the difference in the Guam medical healthcare landscape compared to that of the United States.

They said although Guam has a much smaller population than the U.S., the percentage of people on the island who are beneath the poverty line is greater than that in the U.S. In addition, clarifications must still be made as to what provisions apply to Guam in its status as a U. S. territory.

The benefits as well as the negatives were discussed during the forum. According to Gerry Crisostomo from NetCare, the cost for health care would rise exponentially without Obamacare.

Possible implications of Obamacare would be that customers would benefit, it would prevent unreasonable rate increases, provide greater access and affordability of health care through the proposed healthcare exchange, provide $58 million to Guam for Medicaid funding, and provide medical loss rebates.

In addition, health insurance companies would not be able to increase the cost of services due to pre-existing conditions, or charge based on demographics.

A concern is that the federal government may assume greater powers, such as the power to design insurance plans for states and territories, and can tell people where to get coverage as well as dictate to healthcare providers how much to charge for their services.

In addition to the individual, small group and large group mandates, the scope of Medicaid might also expand. For Guam, this means more people, based on their income, will be more eligible for Medicaid. Joaquin Perez, a representative from Delegate Madeleine Bordallo’s office, stated Medicaid may become the largest healthcare provider on Guam.

Another issue is that the government of Guam may not be able to match the funds provided by the Medicaid program. Under Obamacare, GovGuam will be responsible to match 45 percent of the $58 million awarded for Medicaid. This money will have to come from Guam’s budget.

A solution to this may be found in the fact that most of those uninsured are GovGuam employees who decide not to purchase a group plan with their employer. Because of this, GovGuam could opt out of the Medicaid expansion mandate.

The rise of single-payer systems may also be a consequence. In a single-payer system, one entity would collect all healthcare fees and pay out all healthcare costs.

Many of its provisions have already been enacted since Obamacare was first introduced in 2014. However, the full impact of the law would not be fully realized until it meets its peak in 2014 when mandates are expected to be fulfilled.