COEUR d'ALENE - Julia Sheets was surprised to learn that 80 percent of the cost of health care in the United States is being used to treat just 20 percent of the population.

Sheets was among roughly 75 people who attended a health care forum Monday at North Idaho College on the Affordable Care Act, or Obamacare.

"I need to know more about it," said Sheets, a retired nurse from Coeur d'Alene.

Ronald Lahner, general counsel for Kootenai Health, led the forum, and said the health care reform addresses health insurance coverage and delivery of care.

"It's the coverage part that really received a substantial amount of attention," Lahner said. "The debate was framed by politics and the media."

Many people have heard about the mandates and the insurance exchanges, he said.

"But unfortunately, in the course of looking at the coverage and insurance pieces, I think a lot of other principle pieces of this legislation have not received adequate attention and they really are important," Lahner said.

Lahner, who has worked in health care since 1980, said there are many elements of the Affordable Care Act that were being put in place years before the act was signed into law. Business tools and strategies that have long been used successfully in other industries have been brought into health care, Lahner said.

"The rate of increase in health care costs is starting to come down," Lahner said. "I think we are seeing some results from some of these things."

There are measures built into the Affordable Care Act that require health care providers to be accountable for the quality of care received by those they treat, he said. Health systems that take Medicare will now face a penalty if a patient is re-admitted to the hospital after receiving care and being discharged, or if they acquire new conditions while hospitalized.

The act moves health care from a procedure-based payment model, to one that incorporates performance and value, he said.

There are also elements of the law that are designed to encourage people to take better care of themselves. For example, the Affordable Care Act requires fast food restaurants to provide nutrition information on their products.

During a question and answer period following his talk, Lahner was asked how the health care reforms address a shortage of primary care physicians.

He said the act provides reimbursement incentives for primary care doctors, to stem the tide of physicians lured to specialties where the compensation is now much higher. Family physicians will be better-compensated for taking on greater responsibilities, he said.

Lahner said he's pleased that many of the things they were discussing more than 30 years ago are now part of legislation.

He remains concerned "about the balance between penalty and mandate" regarding the coverage section of the health care law.

"Will that really cause people to get their insurance? That's the idea. We need to get people out of the emergency room and into an insured product," Lahner said.

He said he hopes the new system works.

"I believe that doing nothing is not an option for us," Lahner said.