The prescription for how to bear the good, the bad and the ugly of the Patient Protection and Affordable Care Act (PPACA) tracks with individual symptoms, according to Arizona experts, and a spoonful of sugar most likely is not going to make the medicine go down any easier for some Americans or their lawmakers.
“It really should be called the ‘Accessible’ Care Act,” said Ed Gussio, owner of local insurance brokerage Benefit Logic, Inc. “Affordable is all in the minds of those buying it. It’s very expensive. If you are looking at it and get a subsidy, affordable comes into play…the world looks good to people who were previously uninsurable or have an income level which qualifies them for a subsidy or cost sharing.”
Gussio contrasted that outcome to the reality for “one of the millions of people” who already had health insurance, did not qualify for a subsidy, faced an insurance cancellation, had to buy a new plan, paid more in premiums and/or assumed a higher deductible.
Arizona is one of 27 states participating in the federal Health Care Marketplace. By April of this year, 2,161 of an estimated 14,554 potential enrollees in Coconino County – City of Flagstaff – had selected a Marketplace plan, according to the Henry J. Kaiser Family Foundation. That 15 percent take rate compares to 19 percent overall in Arizona, a high of 87 percent in Vermont and a low of eight percent in Massachusetts.
In the November 2014 Kaiser Health Tracking Report, 24 percent of those surveyed nationally said the PPACA had hurt them, 16 percent stated it had helped and 59 percent reported no direct impact. Among those surveyed who said the law had hurt or both helped and hurt, increased costs were the most reported negative effect, while access to coverage and care were the top reasons cited as helping.
“The challenges I would have as a consumer, as a physician and as a patient are not all the same,” said Dr. Bradford Croft, owner and physician at East Flagstaff Family Medicine. “[Lawmakers] need to revisit the true affordability of [the PPACA], because conceptually, it made a lot of sense, but from a practical application, they really didn’t vet it enough to ensure that they really had affordable care.”
From the medical practitioner’s perspective, the law exerts more control over how medicine is practiced, health care is managed and services are reimbursed.
Dr. Croft said family care practitioners are being asked to “do much more and provide more care in the same amount of time,” while managing more demanding and potentially non-reimbursable paperwork. The end result, he says, is being pulled away from patients for administrative tasks, and from a business owner’s perspective, losing revenue.
Offering health care benefits to employees in recent years, Dr. Croft continued, especially now under the PPACA, has “significantly increased my cost for the business to support those benefits to the point where employees have to pay in to premiums and assume high deductibles. We’ve really had to rethink the insurance benefit as part of the employment package to the point where we may have to throw up our hands and direct them to the ACA.”
Current reform addresses underwriting, enrollment and plan design, when the problems of health care in America involve uninsurable individuals and low income affordability, according to Gussio. He says he would like to see more affordable health care plans, more latitude on deductibles and fewer restrictions on plans that could be offered.
Dr. Croft says the “spirit of the ACA” places patients in primary care for earlier intervention, less expensive care and more comprehensive treatment, focusing more on prevention than disease management. Much of that is being accomplished through Accountable Care Organizations (ACOs), pools of medical practitioners in private or corporate hospital networks.
While primary care is the goal, Dr. Croft explains, incentives in the for-profit system get in the way. “As long as there is profit to be made, [everyone] will be pulling at medical care for their advantage. You would have to get away from fee-for-service medicine…completely redesign how the system is set up and reimbursed. It’s a really difficult transition.”
From an insurance broker perspective and working with every carrier in the state, Gussio clarified that his company and others “know what people want and need. Lawmakers are not in touch… All of these grants for navigators [are] a huge waste of money. At the end of last year, the navigators were referring people to us. The most important thing is to be more in touch with people like us who are working with people and businesses day in and day out.”
For their part, patients need to “have more accountability for themselves and in talking to their primary care doctor,” Dr. Croft advised. “Everybody gets physicals and that’s part of the law,” but basic health maintenance – such as eating and exercising properly – is an important part of the formula. It may be a harsh fact, but the end result often “is nobody’s fault but the guy in the mirror.”
The sign up for individual health care plans under the PPACA ends Feb. 15, with those plans going into effect Mar. 1, Gussio says. Businesses with 100 or more full-time equivalent employees (FTE) are required to insure them by Jan. 1 or face penalties. That same requirement for businesses with 50 through 99 FTEs has been delayed until 2016. FBN
By Sue Marceau
Flagstaff Business News
Leave a Reply