Coverage of the Affordable Health Care Act is set to start in January, and the impact in Arkansas is still difficult to predict.
Throughout the country, insurance companies, government agencies and health care providers are trying to anticipate costs and patient needs.
The program is supposed to provide affordable insurance policies to millions of people who have jobs, but don’t currently have access to insurance.
From 2009 to the present, more than 100,000 people in Arkansas have lost or dropped health insurance, according to Arkansas Center for Health Improvement, a non-partisan research group. Overall, there are more than 572,000 Arkansans without any health insurance, according to the Arkansas Health Connector.
The extent to which the new law will help those currently uninsured is unknown.
Impact on hospitals
Hospitals routinely provide care for people with no means of paying the bill.
Data from the Arkansas Center for Health Improvement indicates more than 13 percent of patients aged 18 to 64 years were uninsured when they were hospitalized in 2010. That’s about 12 percent of adult hospital stays, with a total cost to Arkansas hospitals of more than $160 million.
Proponents of the ACA believe the new program will change that trend.
“We continue to be hopeful that we’ll see fewer uninsured people,” said Shawn Gremminger, assistant vice-president for legislative affairs for America’s Essential Hospitals.
The organization is comprised of some 200 teaching hospitals in the United States including the University of Arkansas for Medical Sciences in Little Rock.
Gremminger said the hospitals expect to write off a percentage of their annual operating costs as they provide services to the uninsured.
“The patient may be able to pay for some part of that but the anticipation for many hospitals is that they are not going to be able to pay,” Gremminger said. “In many cases, the hospital just chalks that up to charity care and that’s it — they just won’t get paid for it.”
However, the hospital isn’t bearing the total cost of those services. A government subsidy program exists for disproportionate share hospitals — hospitals that provide a disproportionate share of services to uninsured patients.
The situation changes when the patient has basic insurance coverage that might pay 60 percent of hospital bill. In that case, the hospital has been paid a pre-negotiated amount by the insurance company. Even when the patient is unable to pay the reminder, government subsidies are taken off the table.
“That federal subsidy is only available when the patient is uninsured or covered by Medicaid,” Gremminger said.
Gremminger said smaller hospitals have even greater limits on dealing with the cost of caring for uninsured and underinsured.
If there aren’t safeguards in place by the time the hospitals begin feeling that pinch, the possibility exists that smaller, private hospitals and clinics could close or limit services.
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For Arkansas residents looking to gain coverage, cost will differ depending on the region where the resident lives.
The cost of plans, according to the Arkansas Health Connector, is based on the cost of available local health services.
In Arkansas, the state government is going to subsidize the cost of premiums for families that qualify. That approach isn’t a nation-wide program.
The three basic plans cover 60 to 90 percent of the cost of healthcare. Gremminger said it’s the expectation of many in the health care field that the bronze plan, which pays 60 percent of costs, will be the most popular because the premiums are cheaper.
While having a plan that covers 60 percent is better than having no insurance at all, it does raise some issues.
Gremminger uses the examples of a hypothetical, low-income resident who is hospitalized. The person’s insurance plan has agreed to pay up to 60 percent of the bill. For a $10,000 hospital stay, the plan will pay $6,000 and the patient is responsible for $4,000. When that patient had no insurance, the hospital had little expectation the patient would pay — but relied on the government subsidy to make up some of the cost.
“But now the hospital wants its other $4,000,” Gremminger said. “And can that person afford $4,000?”
Some officials fear those situations could lead to aggressive billing practices.
Changing face of health care
With no health insurance, many people ignore health issues until the situation requires expensive emergency care.
John Bowen, director of the Baptist Health Medical Center-Arkadelphia, said health care reform could change that, with more people turning to primary physicians for routine care rather than going to the emergency room.
“The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care,” the ACHI concludes in a public report.
For many without insurance, a wellness checkup and routine physical are out of the question.
Kerry Krell, public information specialist for the Arkansas Department of Health, anticipates more people in Arkansas will seek out those services if they have insurance to cover at least some of the cost.
“With increased access to and coverage of preventable services, we anticipate that chronic disease rates and their resulting complications will eventually decrease,” Krell said.
Krell said the ADH doesn’t anticipate changes to the demands on its services.
“We actually don’t anticipate a change in the number of people we will treat because we provide local access for particular care such as immunizations, family planning, sexually transmitted infections and tuberculosis,” said Krell. “Also, the majority of our patients are currently on Medicaid. We are prepared to continue to serve all the people who come to the local health units for the services that we provide.”