Archive for Sunday, May 26, 2013

Local providers gear up for health care exchanges

May 26, 2013


Heartland Community Health Center would certainly look a lot different if not for the Affordable Care Act.

A few years ago, the Lawrence practice treated a few thousand uninsured patients a year. But since it became a federally qualified health center under the law known as "Obamacare," it began expanding its capacity by 75 percent and will soon treat a 50-50 mix of clients with and without coverage. But to do so, many of its patients will need to sign up for the low-cost insurance options provided by the health care reform act.

Heartland, like other local providers, is grappling with how to get the word out about the expanded coverage that will be available when the law's online health care exchanges take effect in a little more than four months.

"Whenever you implement a new plan, our first goal is to educate the patient on what the plan does for them," said Tim Bredehoft, staff pharmacist at Lawrence-based Medical Arts Pharmacy, which helped customers enroll in the Medicare Part D prescription-drug program when it started in 2006. "Once we know more about (the new law), we're definitely going to be spreading the word to our patients and beyond."

The Affordable Care Act, passed in 2009, is designed to provide universal health care coverage to all Americans by expanding Medicaid, mandating that citizens have insurance and implementing health care exchanges for consumers to purchase subsidized premiums. More than 18 percent of Douglas County residents, or about 16,000 people, are uninsured.

Still, the public remains widely uninformed about "Obamacare." Recent polls have found that 4 in 10 Americans were unaware it was still a law; 62 percent didn't know tax credits would be available to purchase insurance; and 90 percent had no idea when they could start shopping on the exchanges.

So it's up to providers, insurers and consumer organizations, among others, to ensure Americans make informed decisions when the health care exchanges begin open enrollment Oct. 1.

Kansas health care exchange

• Residents who earn between 100 and 400 percent of the federal poverty level are eligible for subsidies automatically deducted from the price of the insurance, so they spend no more than 2 to 9.5 percent of their income on the premiums.

• Certain small businesses with fewer than 25 employees will be eligible for a 50 percent reduction in their health care costs if their staff purchases coverage through the exchange.

• During open enrollment, from Oct. 1 to March 31, insurers will not be allowed to deny coverage to people with pre-existing conditions or charge women more than men (enrollment is closed from April 1 to fall 2014).

• The plans — offered by Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City and Coventry — will consist of essential health benefits and are said to be more robust than what most insurers currently offer.

• Kansas' exchange is being run by the federal government because the state, like 26 others (most with Republican governors), decided not to create its own.

"A lot of the heavy lifting is going to be done by the government itself," said Robert Lee, a professor of health care economics at Kansas University. "I would anticipate a very significant outreach and publicity campaign that will be starting up probably in September and October. The experience in other places — in Massachusetts and other countries that have done this sort of things — suggests it takes a while for people to understand what's going on and the opportunities available to them."

Lawrence's Health Care Access Clinic will continue to serve patients who fall through the cracks of the system. The practice saw 3,000 uninsured Douglas County residents last year, serving people who fall within 185 percent of the federal poverty level. Executive Director Shelly Wakeman said the clinic won't be impacted by the new law unless the state of Kansas decides to, as the Affordable Care Act calls for, expand Medicaid. In that case, many of Health Care Access' patients would qualify for coverage and move on to other providers. Even then, the law isn't likely to be 100 percent effective, she said.

"We see people who are undocumented. And Medicaid is complicated. People have to recertify — if they don't have the right documents, they get kicked off," Wakeman said.

The Lawrence-Douglas County Health Department likely won't be affected by the exchanges, as it generally provides preventive rather than sick care. Lawrence Memorial Hospital, meanwhile, has yet to announce how it plans to educate patients about the new coverage options.

For its part, Heartland Community Health Center is applying for federal grant funding to hire another full-time employee to provide outreach and screening for the Affordable Care Act. The social worker will assist patients in determining their eligibility for insurance and help patients enroll in the exchanges.

Although the law is unpopular and misunderstood by many Americans, Heartland CEO Jon Stewart says the discussion it created will ultimately be for the greater good.

"I think one of the worst things about the Affordable Care Act is the controversy it stirred up. But I think one of the greatest things about the Affordable Care Act is the controversy it stirred up," he said. "I think if we can get beyond the political part of the conversation and think about what really needs to change in health care, then we can really make some movement. I think it's been a sorely needed conversation in the United States."


Alceste 5 years ago

Just simply fantastic Brownback and Co. were so stupid as to let Uncle Sam create, design, and control the exchange for Kansas.

This unmitigated hubris by Brownback and the elected (no Kansans get a big fat F-) allow Kansas to have a fairly decent health care exchange under the ACA. Please, Brownback, continue to be so stupid. God only knows what his "inner circle" could have been created had they had one iota of forethought.

chootspa 5 years ago

Instead of adopting the Heritage Foundation/Romneycare plan, he should have opted for a single payer system or at least included a public option.

Alceste 5 years ago

rvjayhawk: you mean like the 44 million people in this country who have no health insurance, and another 38 million who have inadequate health insurance for a total of 82 million Americans who already have the same level of "care" that "third world countries" provide? Cool. Just wanted to be certain Alceste understood and understands the effort to make quality health care available to the 1% ers around these here parts.....

Leslie Swearingen 5 years ago

I am so glad this law was passed. I remember my family and myself watching anxiously as Congress voted and how we cheered. Of course, it is complicated, it is a law and so has to be worded a certain way. It is comprehensive and covers the majority of health concerns.

In our family having the granddaughter be able to stay on her fathers insurance plan until she is twenty-six was important as she was able to have needed dental work done. The requirement that insurance companies cannot turn away someone with a pre-existing condition is vital to the health and well being of so many people.

Once this has been implemented I am sure that after a short time people will forget why they were ever opposed to the ACA.

Jon Stewart 5 years ago

Keep in mind that it is well-documented that our health care system has been by far the most expensive of all industrialized nations for decades. This might be acceptable if our system yielded the best outcomes. Unfortunately, the opposite is true. We are spending the most, yet health outcomes rank at or near the bottom among industrialized nations. To top it all off, the trend has been steadily worsening; healthcare in the US is becoming ever more expensive and outcomes are getting worse. Rather than causing this situation, Obamacare is a response to it... an admittedly imperfect response at that.

It has been long forgotten that some of the basic components of the ACA (the individual mandate, retaining commercial insurance options) were and are originally Republican ideas proposed in the 90s.

Clearly it is a very political topic which leads to very heated political debate. Beyond the political wrangling however exists a system that simply cant be sustained.

roadwarrior 5 years ago

it's just a very good thing and thank you Heartland for offering basic care without the hard sell of expensive and unnecessary treatments simply because the insurance company will pay for them.

akt2 5 years ago

Forms and more forms. Government red tape and long waiting periods to have physician ordered diagnostics or therapies authorized by KanCare, formally Medicaid. They can't keep up now. I hate to see what Jan. 2014 brings. Being insured is one thing, utilizing it is the hard part. Reimbursements for providers will likely take forever as well.

appleaday 5 years ago

Insurance companies are far more inefficient in their operations and generate as many, if not more, forms. What you all keep forgetting is that we pay for health care for the poor already in the form of higher insurance premiums, greater out-of-pocket expenses, and the intangibles caused by a large portion of the population who are overweight and out of shape (at higher rates in the poor population). Every time an uninsured patient seeks care in the emergency department of a hospital (because they can't afford preventive care and don't seek care until they are very ill), the hospital passes that expense on to every "paying" customer they can. If we can get more people into the "insured" system, we can spread these costs a little more equitably than we do now.

Mike Ford 5 years ago

listen to the fox talking point people on here.....(laugh)

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