UTICA — The U.S. Supreme Court’s June 28 decision to uphold most of the federal health-care reform law, dubbed the Patient Protection and Affordable Care Act, brought some certainty in that implementation of the law will continue. But after the court’s ruling, area health-care providers and insurers are still left with many questions about how the law will change health care when much of it goes into effect in 2014.
The court decision, and the law, create a bit of a double-edged sword for providers, says Michael Haile, CFO of Faxton St. Luke’s Healthcare in Utica.
“It’s great that we’ll have more people with insurance,” he says. “We’re just concerned with reimbursement for them.”
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The government reimbursement level is already below the cost of service, so the concern is how facilities will continue to make ends meet when they are providing more care to more people — with the same inadequate reimbursement rates.
Currently, government reimbursement rates run about 80 percent of the cost of service for Medicare patients and between 50 percent and 60 percent for Medicaid patients, Richard Ketcham, president and CEO of St. Elizabeth Healthcare, says. The cost of providing care will only increase as more people are enrolled in insurance programs, he says, but there is no real plan in place for funding those costs.
U.S. Sen. Kirsten Gillibrand (D–N.Y.) praised the Supreme Court for its decision. “I am pleased the Supreme Court reaffirmed the hard-fought progress that was made to ensure that no one can be denied coverage for a pre-existing condition, being a woman will no longer be a pre-existing condition, young adults will be covered, prescription drug costs for seniors will be reduced, preventive care, including life-saving mammograms, will be accessible, and that insurance companies can’t cancel their coverage when you get sick,” she said in a news release issued June 28.
While those features are good things, Ketcham says not only is there not a plan in place to pay for them, but there also isn’t a plan in place to make sure there are enough physicians available to provide care for all the newly insured.
Previously, the uninsured would often visit the emergency room, where they couldn’t be turned away from receiving care. The changes that will come with the Affordable Care Act are designed to steer people toward primary-care services, but there aren’t enough primary-care doctors available now, he says.
“It’s just a tremendous problem getting access to physicians,” Ketcham says. Most people entering the medical profession don’t choose family practice or primary care because those jobs are typically lower paying than surgical or specialty-care positions, he says.
There needs to be a plan to incentivize new doctors to enter those fields to ensure there are enough providers available to provide care for everyone, he says.
Other changes are necessary as well to make health-care reform truly effective, say officials from MVP Health Care, a Schenectady–based health-insurance provider that has 41,000 members in Central New York.
“This includes addressing America’s real health-care problem by introducing legislation to reduce the unsustainable increases in the cost of health-care services and products,” MVP President and CEO David Oliker said in a news release. “Some of the most promising ways to control costs are to incentivize providers for delivering quality outcomes in a cost-efficient way, to promote the use of evidence-based medicine, and to encourage the meaningful use of health information technology/electronic medical records and e-prescribing.”
While MVP says it supports the desire for everyone to have health insurance, it opposes the law’s tax on health-insurance companies. According to MVP, estimates are that the tax would cost health insurers $87 billion between 2014 and 2019 and would be passed on to employers and consumers.
In a separate interview with sister publication The Central New York Business Journal, Oliker says health insurers also have plenty of work to do to prepare for state-run insurance exchanges. Although New York’s exchange is not yet online, it is slated to open for state residents to purchase coverage at the beginning of 2014. That leaves about 18 months for MVP to plan, Oliker points out.
“The products have to be designed,” he says. “We need to think about how they’re going to be supported as far as our networks are concerned — that is, the providers that are going to be involved.”
Some plans cannot be solidified yet, Oliker continues. MVP does not yet know the exact rules for insurance sold on New York’s exchange.
“If we had that information, we would certainly run with it,” he says.
An immediate change insurers face is a requirement to provide members and prospective members with “Summary of Benefits and Coverage” documents. Those documents, designed to provide standardized summaries of health plans, will be required starting this September.
