The debate continues to rage over whether the Affordable Care Act, or “Obamacare,” will be the health community’s greatest fix-all or the nation’s worst economic nightmare. But in the midst of all the confusion and speculation, Dan River Region residents can be sure of two things — changes are coming, and local health care providers are ready.
The new healthcare marketplaces opened Tuesday, signaling the start of a three-month period in which people can sign up for new, government-subsidized health insurance plans before the official policy changes take effect on Jan. 1.
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The online marketplace differs a bit from state to state. In Virginia, residents who fill out the website’s application will be provided a list of health care plans available in their area. People with incomes between 100 and 400 percent of the federal poverty level may also qualify for new government subsidies to help offset the cost of health insurance.
According to Saria Saccocio, chief medical officer at Danville Regional Medical Center, these new options means people who have never had access to health insurance before will now be able to receive the care they need.
While the marketplace is open now, the actual changes to how insurance companies must provide for their clients don’t take effect until the start of next year. After Jan. 1, however, things will change dramatically.
65 percent isn’t high enough
Different health care plans will still vary depending on a family’s finances and health care needs, but there are some “essential services” that must be covered by every plan, according to the new government policy:
» Ambulatory services, which are outpatient services a person can get without actually being admitted to the hospital, are now covered. Emergency services, hospitalization, prescription drugs and laboratory services are also included.
» The new system also provides more access to care for mothers, as maternity services, newborn care and pediatric services are covered.
» Wellness and preventative services, as well as chronic disease management and rehabilitative services must be included.
One of the most important services that are now covered deals with mental health and substance abuse, Saccocio said. These services include counseling and psychotherapy.
“ This is so critically important. What we’ve found is that for people with conditions like depression and anxiety, if we can get them to treatment they need for these things, they end up at the doctor’s much less frequently,” she said.
Another major change is that insurance companies will no longer be able to deny a patient coverage for a preexisting condition.
While these changes seem pretty basic on the surface, the new health care system has caused plenty of confusion and concern among patients, health care providers and insurance companies.
One of the biggest immediate concerns is the possibility of medical facilities becoming inundated with new patients seeking care they can now get at much cheaper personal costs. Some critics of the new system say this will clog up the medical pipeline, meaning patients will have to wait longer for services, receive less time with a physician and ultimately get lower-quality care.
Saccocio said DRMC is looking at several ways to try and avoid this problem. First, she said, hospital staff is trying to educate people on the importance of preventative services, which she says starts with having a primary care physician or “family doctor.”
In 2010, only 15 percent of patients who visited DRMC’s Emergency Department identified themselves as having a primary care physician, Saccocio said. That number is now up to 65 percent.
“ Of course we’re not satisfied with 65 percent,” she said. “We’ve really expanded our regional focus to include more primary care providers, intermediary care, and to try and keep people from developing chronic problems and out of the emergency room.”
“ What I’m hoping is that by preparing for the last couple of years, we’ve got greater access to this care that in many other areas of the country,” she added.
The new system also helps navigate people through their medical service options, meaning patients will better be able to identify the kind of care they need instead of simply rushing to the Emergency Department, Saccocio said.
“ The new system, I think, is actually pretty good at pointing people to the care they need, when they need it,” she said. “And it’s partially our job to help people understand when something is an emergency, which is a much more expensive service, and when they can just go to their primary care doctor.”
Lots of questions to answer
Despite being on the frontlines of health care, Saccocio said many in DRMC staff have questions themselves about how these new changes will actually play out. The system, she said, is confusing even to someone who has been in the medical field for years.
“ I’d say [DRMC staff] are like most Americans,” she explained. “They have questions, they’re wondering how all this will work.”
It’s hard to determine exactly what solutions and problems the new system will cause until the changes are actually implemented. Still, hospital administrators are doing everything possible to make sure their staff understand the new changes and can help guide their patients through the process, Saccocio said.
“ We’ve been preparing for this for the past two years, training our staff to be able to answer patients’ questions and help them through all this,” she said. “And we’ll continue to do that, and provide additional training if necessary, to make sure our patients get the best care possible.”
Another health care provider that’s been prepping for the new system is the Danville branch of the Piedmont Access to Health Services.
Executive Director Kay Crane said she’s confident the local clinic is ready for the changes, and said she’s excited about being able to offer health care services on a wider scale.
“ Already about 48 percent of our patients are uninsured,” she said. “So we’re happy about the opportunity to expand our services to more people.”
Like Saccocio, Crane said educating patients in preventative care will be essential to keeping the health care system from getting backed up.
“ Like with any facility, it’s important to manage demand,” she said. “Prevention is so important with this and in helping patients understand their responsibility to maintain their own health.”
PATHS is striving to help patients manage issues such as weight loss, diet and diabetes, among others, to help keep them out of doctor’s offices and emergency rooms, Crane said.
Crane also said the facility will look at hiring more employees to handle patient demand, if necessary.
But despite anticipating some good changes, Crane said she’s still concerned that even under the system, some of the poorest members of the community may still be left without health insurance.
While the new health care options offer government-subsidized plans for people between 100 and 400 percent of the federal poverty line, there’s still a large gap between those people and the ones who currently qualify under Virginia’s Medicaid program – which says those under 30 percent of the poverty line are covered.
Except for special cases such as pregnant women, children and the disabled, Crane speculates many locals who fall into this 30-to-100-percent category will remain without insurance unless Virginia decides to expand Medicaid.
“ I’m really worried about these people, and we’re projecting that there could be thousands of them,” she explained.
Under Obamacare, states who choose to expand their Medicaid programs can receive millions in federal dollars to help offset the cost. So far, the General Assembly has denied this expansion, expressing concern that after those three years the state will be left to pick up the slack.
Crane says that in the meantime, these patients will be left without insurance.
“ I wish they would just expand it, figure out a way to do it,” she said. “Maybe that makes me an optimist, but these people need care.”
The new system definitely needs to be tweaked and modified to both solve these problems and any others that might arise, Crane said. But she also noted that the Danville PATHS clinic is ready to assist any patients who may have questions, concerns, or trouble enrolling in a new benefits program.
PATHS has received federal grant money to hire two full-time outreach specialists, and another part-time one. These specialists will be available to help anyone — whether they are patients of the clinic or not — make the transition. They will also be visiting churches, community events and other areas to answer residents’ questions and hand out information on health care.
“ This first year is going to be trial and error,” Crane said. “Many patients are confused, and there are a lot of myths about this thing. So we just want to help them understand as best we can.”
“ But I’m excited about it,” she said. “I think it will be a really good thing for our patients, and for us. We’re ready to move forward.”
Hughes reports for the Danville Register & Bee.
The Affordable Care Act and you
» Anyone with questions about the new health care system and how they can get coverage are encouraged to call 1-888-982-9144 to speak with a certified application counselor at Danville Regional Medical Center, or to schedule an in-person appointment at DRMC or Memorial Hospital of Martinsville and Henry County.
» Dan River Region residents can also visit www.pathsinc.org to find the PATHS clinic nearest them. Outreach specialists are available to help navigate the new system.
(Posted: October 6, 2013 at www.godanriver.com / Story by: Brittany Hughes)