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Affordable Care Act has health industry in flux

Published: Saturday, Sept. 14, 2013 5:30 a.m. CDT • Updated: Saturday, Sept. 14, 2013 11:53 p.m. CDT

This is the third in an occasional series from the Daily Chronicle that will examine the multiple changes to health care in America in 2014 because of the federal Affordable Care Act . Stories will focus on how local families, businesses and health care systems will be affected by the various aspects of the law.

The health care landscape is shifting for Joe Dant.

The KishHealth System vice president of business development said the organization’s hospitals are stressing preventative care, which is one of the ways the health care industry as a whole is trying to accomplish the goals of the federal Affordable Care Act.

Improving quality and lowering costs can happen by keeping people healthy so they don’t have to come to the hospitals. It’s quite a different approach for Dant.

“We’ve been trained for 200 years to just take care of you when you come to the hospital,” Dant said, “and now we’re retraining ourselves.”

Hospitals and health care providers everywhere also are training themselves to educate people about the Affordable Care Act, signed in 2010 with provisions being phased in through 2020. Its intent is to make health care more accessible and affordable, and requires most Americans to have insurance and businesses with a certain number of employees to offer it or pay a fine.

Although many local health care providers are uncertain about aspects of the law, they are determined to educate patients and see themselves as potential resources for those wanting to enroll in the Illinois Health Insurance Marketplace, which is scheduled to open Oct. 1. Coverage will kick in Jan. 1.

The marketplace, or exchange, is a website that will serve as a central location for residents and small businesses to compare and choose from dozens of insurance plans. The policies will be divided into four levels – bronze, silver, gold and platinum – that offer different levels of coverage, breadth, depth and services.

The exchange aims to connect thousands of uninsured residents with health insurance providers; depending on income, some will receive subsidies, while others will be enrolled in Medicaid. Anyone can use the marketplace to find insurance, but not everyone will qualify for subsidies.

In DeKalb and Lee counties, about 5,800 people will be eligible for the exchange with tax credits and 1,300 to use the exchange without tax credits because of their income, said Kevin Poorten, CEO and president of KishHealth System. More than 5,400 people in the area will be newly eligible for Medicaid, he added.

The DeKalb County Health Department is in the process of training staff for the upcoming changes to health insurance coverage through the Enroll DeKalb County initiative. Jane Lux, DeKalb County public health administrator, said the staff will be helping people who need assistance enroll.

The county health department received a $92,000 grant from the state public health department to become educators. 

“In some ways this is not a new role in public health because we’ve always helped people in other programs with health care coverage such as moms and infants,” she said.

Uncertainties remain

For many health care providers, uncertainties remain about how the delivery and practice of health care will be affected. Earlier this week, for instance, federal officials said the policies offered and how much they will cost in Illinois won’t be available until the insurance marketplace opens.

Poorten and Dant said the lack of information makes it hard for KishHealth System staff to be ready to assist patients in making educated decisions.

The Illinois Academy of Family Physicians has a similar view.

Ginnie Flynn, vice president of communications for the organization, said there are mixed attitudes about the ACA among doctors, with many members of her organization not certain yet how it will affect their work.

“Especially our younger members,” Flynn said. “We even ask about the ACA to our medical students ... and the overwhelming response is, ‘I’m not sure what is going on.’ ”

Nevertheless, Poorten said the health system is optimistic about the ACA and the exchange, as it represents an incredible change for the health care industry. Eventually there will be more clarity about the initiatives associated with the law. 

“Once that starts to play out, we will figure this out and at the end of the day ... [we will] have an extra 13,000 [people] that are going to have access to health insurance that currently don’t,” he said. “That’s a good thing.” 

Uninsured patients can be costly for health care providers such as hospitals. Danny Chun, spokesman for the Illinois Hospital Association, said there are 1.7 million to 1.9 million uninsured people in Illinois. The association represents more than 200 hospitals and health systems in the state.

Studies show that the uninsured put off care. They’re generally sicker when they finally seek help, making them more difficult to treat as a result. Hospitals tend to be the first and last resort for many of the uninsured. 

“They provide more than $1.5 billion a year for care which they do not receive any compensation,” Chun said of Illinois hospitals.

But providing people with insurance isn’t the same as providing them with care. Dant said based on the information about the rates for the health insurance marketplace in Western states, there are still significant out-of-pocket costs for people with bronze-level plans.

However, that might not hold true in DeKalb County. Even if many people join the bronze level plan, providers will still be paid at the same level as they would with any other insurance company. 

“From a payment standpoint from the provider community, we’re going to be fine with this initial thrust, at least as we know it as of today,” he said. 

The hospital association is encouraging hospital systems to consider applying to be Certified Application Counselors, where a system’s staff and volunteers can help people understand, apply and enroll for coverage, according to an August letter from the organization. 

KishHealth System staff have applied to be Certified Applications Counselors, but there has been a delay in the approval process. DeKalb County Health Department staff also plan to apply to become counselors and are being trained about the Exchange through the state.

Hospitals have been preparing for several years for the changes brought on by the ACA, Chun said. They have been developing partnerships across communities, expanding outpatient services and figuring out the best way to coordinate services so people get the best care they need.

“Everyone recognizes they will have to do things more efficiently,” Chun said. 

Know more

DeKalb County Health Department staff are training to provide information on the Affordable Care Act, the Health Insurance Marketplace and assist people with enrollment in the Health Insurance Marketplace, which is planned to accept enrollments on Oct 1. To learn more about Enroll DeKalb County, visit http://shawurl.com/rwp.

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