Hospitals, providers navigate health care reform law

Some see the Affordable Care Act as an ever-evolving process that makes many people scratch their heads and wonder what it will mean with regard to health insurance costs and coverage.

Health care providers and insurers, however, claim they had taken the necessary steps to be ready when major provisions of the plan kick in beginning next year.

Just this past week, however, President Obama announced changes giving insurance companies the option to keep offering for up to one year those consumer plans that would otherwise be canceled.

Celeste Curley, senior director of product management for Blue Cross of Northeastern Pennsylvania, said a main focus of the health insurer has been meeting requirements of the Affordable Care Act.

It meant taking a hard look at some of the Wilkes-Barre-based company’s insurance products and seeing if they covered everything required under the new federal law.

“We determined our current individual products did not meet our essential Affordable Care Act requirements, so we had to completely revamp those products,” Curley said. “We notified people Oct. 1 that their current plans were being withdrawn. They would have to select new plans either through the federal marketplace or through us.”

The Affordable Care Act requires most health plans in the individual and small group markets to cover 10 essential health benefits, including hospitalization, prescription drugs, maternity and newborn care, mental health, and rehabilitation services.

All told, that affected about 8,000 Blue Cross customers.

And then came the most recent change to Obamacare.

The question is what happens now, including with customers who already had their previous plans canceled?

Blue Cross officials were pretty much silent on this most recent development.

“We are evaluating the situation and will not comment until further analysis is complete,” said company spokesman Anthony Matrisciano at week’s end.

“This is a new development,” said Christopher Fanning, vice president of commercial sales for Geisinger Health Plan. “We spent a lot of time working to comply with the Affordable Care Act. While we don’t know the full implications of the announcement, it will have an impact on our business and our

members. We are currently talking with the Pennsylvania Department of Insurance on how they want us to proceed. We will work to make sure any transition for our employer groups and members is as smooth as possible.”

At any rate, it appears those most affected by the Affordable Care Act will continue to be people without insurance or on individual plans.

For those who receive coverage through their employers, the new federal law has less of an impact.

For example, a healthy person who receives coverage through a large employer isn’t likely to see a big change other than the usual annual premium rate increase.

Curley said premium rates for customers will go up or down depending on any number of factors.

Young and healthy people will likely see their rates increase.

“But it really depends on income levels,” Curley said. “Those with low income levels could be subsidized. One population who will see rates go down are those with existing medical conditions. In general, our healthier people will subsidize (others).”

Overall, the Affordable Care Act will likely present financial challenges for Blue Cross.

Some 85 to 90 percent of health care costs are driven by the care costs, according to Suzanne Fletcher, Blue Cross’s program leader for health care reform and vice president of finance and administrative services.

“The Affordable Care Act hasn’t addressed that,” she said. “In the meantime, health care costs will go up.”

Both Fletcher and Curley refused to criticize the new mandates.

“The fact we are offering insurance and making it more affordable for people is a very good thing,” Fletcher said.

No one can be denied coverage under the new law, but some people remain unsure.

Margie Sauers, a social worker with Lycoming/Clinton Joinder Services, was led to believe that some cancer patients could be refused insurance.

She said it’s been easy for many people to be confused by the rumors surrounding the new law.

“What is the truth and what isn’t?” she said. “I think we will just have to learn as we go and see what happens.”

For Susquehanna Health, the Affordable Care Act is in many ways a win-win situation.

“In theory, if patients who previously didn’t have health insurance become insured through the ACA (Affordable Care Act), Susquehanna Health will be compensated for their care instead of having to absorb the cost of those services,” said health system spokeswoman Tracie Witter. “Susquehanna Health provided $4.6 million in charity care in 2012. This is care for which we receive no revenue.”

Witter said the Affordable Care Act will mean reimbursements based on quality of care rather than patient volumes, which should bode well for the health system.

She pointed to Susquehanna Health’s quality record and patient outcomes.

Witter said the most recent change to the Affordable Care Act allowing insurance companies to continue providing current coverage that would otherwise be withdrawn should not impact the health system.

“No, as long as the patient does not have any lapse in insurance coverage, it won’t have any direct impact on us from a reimbursement standpoint whether they are able to keep their current policy or purchase one through the insurance exchange,” she said.

Witter also addressed a trend in health care requiring employees to pay a greater share of insurance coverage.

“For the employee this can mean higher payroll withholding, higher deductibles and higher co-payments,” she said. “For our patients, this means they may be billed for their hospital stay or outpatient procedure that is higher than what they may have experienced in the past. This is the direct result of a change in their employer-based health plan that is now requiring them to pay a larger share of these costs.”

At Geisinger Medical Center, the situation may be a bit murkier.

Angela Long, associate vice president of revenue management, said she couldn’t say for sure if health care costs will go up as the result of the Affordable Care Act.

“What we try to see as an organization is where we can provide most quality and efficient care for patients,” she said. “We are always trying to keep our costs down. With any changes related to how our payers pay us, we are always looking at things. We expect our reimbursement rates to come down. We want to try to make sure our costs won’t rise to make up for that.”

Long said the Affordable Care Act isn’t likely to bring about extra headaches for people in the way of filling out additional paper work or navigating a confusing process.

“If anything I think it is opening up access,” she said. “Clearly, there are enrollment forms to sign up for coverage.”

But once that initial process is complete, there really are no additional procedures to go through.

Long said Geisinger has really gone the extra step in helping people understand the Affordable Care Act and sign up for insurance that best meets their needs.

She referred to the health system’s Trusted Advisor Program staffed with trained personnel who help guide people through the process.

“We have really tried to put info out there to the fingertips of the community,” she said. “The Affordable Care Act is a 1,000-page document.”