Coverage won’t take effect until Jan. 1 at the earliest

Last updated: September 30. 2013 11:50PM - 2793 Views
By - mguydish@civitasmedia.com

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The new health insurance exchanges mandated by the Affordable Care Act opened for business today, and while the rhetoric and political wrangling in Washington may have made it sound as important as D-Day in World War II, local health professionals caution against overreacting.

“There is all this hype about it and patients are very concerned and worried, so they are looking for people who have complete information,” Geisinger Chief Medical Officer for Population Health Dr. Thomas Graf said. “The challenge is that it’s pretty confusing to work your way through it.”

The important thing for many to remember, Graf said, is that while the exchanges launch today, if you qualify and if you use them, you are signing up for coverage that doesn’t begin until Jan. 1 at the earliest, and you have until March 31 of next year to pick a policy.

Which is not to diminish the importance of understanding what the exchanges are all about, warned Amelia Abromaitis, director of communications for the Service Employees International Union Healthcare Pennsylvania, the state’s largest health care workers union. SEIU held a teleconference and public event in Scranton on Monday to raise awareness of the exchanges.

“Over the next six months or so hundreds of health care workers from Erie to Pittsburgh to Philadelphia and Scranton and everywhere in between will reach out to co-workers and community members to help them,” Abromaitis said, “We want to show them where they can turn to understand what’s going on and where to sign up for the online exchange.”

SEIU has dubbed those involved in the outreach “health care champions,” and licensed practical nurse Chris Sloat of Wilkes-Barre is one.

“A lot of people have so many questions and are so misguided by advertisements,” Sloat said.

The SEIU effort is intended to make sure people know who they can call, including health care “navigators” being set up in many counties through the law, and to understand the basics.

Geisinger Health Plan Public Relations Specialist Amy Bowen outlined those basics. Various private sector insurers, including Geisinger, have applied to and received permission to operate through the exchanges. They must offer plans in four basic groups named after metals to give people an easy starting point in judging what they are looking at.

“They are platinum, gold, silver and bronze,” Bowen said. “What the colors refer to is the amount of the total cost of coverage the insurance company pays and the total cost the patient pays.”

In bronze plans, the company picks up 60 percent of the tab while the patient picks up 40 percent. The percentages change by 10 points at each level, up to Platinum, where the insurance company pays 90 percent of costs. Premiums rise accordingly.

The exchanges are designed to offer choices to those making between 133 percent and 400 percent of the federal poverty level and who are not eligible for Medicare or Medicaid programs, or who do not have insurance through their employers, Bowen said.

The exchanges are intended to go hand in hand with expansion of Medicaid offered to each state through the Affordable Care Act, Sloat said, but there is a problem in Pennsylvania.

Gov. Tom Corbett has opposed the Affordable Care Act and been at best reluctant to implement its provisions. States were given the choice of setting up their own health exchanges or defaulting to one run by the federal government, and Corbett defaulted. He also hesitated in accepting the Medicaid expansion, questioning the state’s ability to pay it’s share (10 percent) and contending Washington’s explanations of how it will work were incomplete. He only recently agreed to the expansion with some restrictions, and his proposal must be approved in Washington.

That means many uninsured people who cannot use the exchanges will remain uninsured at least until Washington approves Corbett’s plan, Sloat said, and that totals about 700,000 people statewide.

Bowen noted that those who do use the exchanges should keep some important points in mind. Rates can vary slightly from region to region for the same plans from the same company, and buyers should look closely at the doctors and providers who are part of a plan’s “network.”

Insurance plans routinely cover more of the costs for in-network providers than for those out of network. While Geisinger’s exchange plans all have the same network, some companies have cut costs by narrowing the network covered at each color level, Bowen said.

People also need to remember that not all companies are available statewide.

Bowen noted that it “was a lot of work” for Geisinger to prepare to compete in the exchange. “We’ve had to change quite a few things, even computer systems and software.’

Graf said one key intent of the exchanges, to cut insurance costs through increased competition, may be in some doubt. He cited results of a study in Oregon in which increased opportunity for insurance coverage led predictably to more people being insured, but that the quality of care differed little between those who had gained insurance under the expansion (done through a lottery) and those who hadn’t.

The real trick to controlling costs is for health care systems to better coordinate services, to increase odds patients get the right care early enough to head off bigger problems down the road, and to focus more on making sure treatment leads to good results, Graf said.

For Sloat, helping make the new exchanges work was personal — she has had cancer scares herself — as well as professional.

“I pay over $700 in health insurance monthly for my family. (The exchange system) doesn’t affect me, but as a nurse I see how it can affect people who are uninsured. They have cancer treatments or other procedures delayed. This isn’t right. Everyone deserves to be healthy.”

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