Residents who attended a Monday morning town hall learned more about the Affordable Care Act (ACA) and raised questions about the cost of the 2010 federal health care legislation.

State Rep. Vicki Barnett (D-Farmington Hills) and Congressman Gary Peters (D-9th Congressional) hosted the meeting at the Costick Center in Farmington Hills. Representing the Michigan Universal Health Care Action Network (MichUHCAN), a grassroots health care policy organization, Maggie Mitchell provided background about the bill, which she acknowledged "is not perfect."

She said health care "should not be a political issue. We are all going to need it. A health care system that works benefits all of us."

However, some who attended wondered whether people who are insured will end up with higher costs, as insurance companies pass on the additional cost of providing more coverage to rate-payers. Paul Goldman, a member of the Michigan Association of Health Underwriters, said penalties established for those who aren't insured are less than the cost of purchasing insurance. 

"I personally agree with the mandate, but the fines are so miniscule," Goldman said, adding he would tell his adult sons they're "better off paying the fine."

Peters said if nothing is done, "health care costs will grow at a rate that is simply unsustainable ... If we don't slow the rate of health care, we'll never get the deficit under control."

Mitchell outlined the basics of the bill, which requires insurance companies to cover people with pre-existing conditions, extends coverage to young adults under their parents' insurance policy, provides subsidies and expands Medicaid to serve people with low incomes, and requires most who don't carry insurance to pay an annual penalty. 

For those who already have insurance, Mitchell said, "you keep what you have." Even with the Medicaid expansion and a mandate that requires most Americans to carry health insurance, about 32 million people will remain uninsured, she said.

There may be changes to the ACA, Peters said, depending on the result of a U.S. Supreme Court challenge to the mandate that requires all Americans – except people who have a religious objection, undocumented immigrants, Native Americans and people who meet certain financial criteria – to have health insurance. 

Barnett said the mandate conversation started with the insurance industry, which needs to cover healthy people in addition to sick people in order to make their companies work. The key to doing that is to encourage as many people as possible to have insurance and impose a penalty on those who don't, she said.

Peters said paying health care providers based on outcomes rather than procedures and putting a greater emphasis on disease prevention are parts of the new legislation designed to bring down costs. He said Henry Ford Health System has already begun to reward doctors based on patient outcomes.

"I have long maintained that we don't have a health care system in America, we have a sick care system," Peters said. 

"The biggest thing the ACA does, for the first time in this country, is it puts an emphasis on prevention," he added. 

Barnett said state lawmakers are taking up legislation to establish a Michigan health care exchange; Peters said nothing much will happen in Congress until the Supreme Court ruling. 

Learn more about the ACA at healthcare.gov and the Kaiser Foundation website.