JEFFERSON Its the only service in America where we dont directly pay for it.

Thats the curious nature of health care in America, especially for those who have some type of insurance that picks up the tab, said Joe Giangola, an Ashtabula insurance professional who participated in a discussion on the subject Tuesday evening. Giangola said that while Americans historically have been isolated from the real cost of care, that is about to change as more than 40 million uninsured Americans must find insurance or face a penalty.

We will add a disproportionate number of people to the pool who are going to file more claims, Giangola said. The people who are paying (rates) are going to see a disproportionate increase (in their rates).

Giangola wouldnt predict where rates will go, although some are predicting increases of 100 percent or more when the health-care insurance requirements of the Affordable Care Act (ACA) kick in Jan. 1, 2014.

The forum, sponsored by the Ashtabula County League of Women Voters, was held at Jefferson Health Care and focused specifically on how ACA will impact businesses, providers and patients. At the end of the nearly two-hour discussion, two things were evident: Health care wont become more affordable for most Americans and there are likely to be negative repercussions lawmakers didnt foresee.

For example, small business owner Bonnie Warren predicts she will have to cut staff if forced to provide insurance for her 135 employees. Warren, the sole owner of the home-care business Comfort Keepers, operates in four counties and has a monthly payroll of $200,000. She said that if ACA forces her to provide health care insurance to her full-time employees, she will have to raise the rates she charges customers.

The minute we raise our rates, we will lose clients, said Warren, who characterized ACA as poorly designed. In addition to laying off workers, Warren predicted ACA will change the culture of her business. Since starting the business 10 years ago, shes given workers the freedom to select their assignments. But in order to satisfy the governments full-time or part-time designations under the ACA rules, she will have to assign workers to cases they otherwise might not have chosen.

The nice flow weve enjoyed for 10 years is not going to be there anymore, she said.

Robert David, president of UH Geneva and Conneaut, has no doubt about the need for health care reform in the United States. He said that ACA will challenge hospitals and other providers to do more with less and achieve the same outcome, or better, that is realized under the current wasteful system.

That waste, due largely to inefficiencies, is estimated at 30 percent of the total spending on health care, which in 2010 was $2.6 trillion, or more than $8,400 per citizen. David said that at that rate, health care will bankrupt the nation in a few years and workers who have paid into the Medicare Trust Fund will not be able to collect.

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Health care law changes will be drastic for many