If you are without health insurance you have until the end of this month (March 31st) to acquire it through the Health Insurance Market exchange to avoid penalties from the federal government. Last Saturday state Rep. Thaddeus Kirkland facilitated a healthcare forum for Chester residents at the Boys & Girls Club for residents to learn more about how to get signed up and what to expect since the passing of the U.S. Patient Protection and Affordable Care Act (ACA) of 2010, commonly called, Obamacare.
Kirkland touted the ACA that mandates health insurance coverage, as a solid achievement of the Obama administration.
“A promise made, a promise kept,” Kirkland called it. “A promise to make sure all Americans have access to affordable health care even with pre-existing conditions,” said Kirkland to about 15 residents, mostly seniors.
Peter J. Rykard, Kirkland’s part time community program director, gave his testimonial experience about the process of securing a health plan through the Health Insurance Market Exchange.
“I work part-time for the representative so that meant I wasn’t covered by health care,” explained Rykard. “Back in September, I was diagnosed with diabetes so that’s a condition where you have to have medical coverage.”
He explained the necessity to visit a doctor would be more frequent with the disease so his need for coverage was high.
“You have to go to the doctors. You have to have insulin and needles, so at that point, that made me feel very frantic. I needed to have some kind of coverage,” pressed Rykard.
He said the process was, at first, a little daunting going through all the plans, but he finally found the one that worked best for his health needs.
“It can be a little traumatic at first because you have the different plans. You’ve got a silver plan. You’ve got a bronze plan. You’ve got a gold plan. You’ve got deductibles and the platinum plan,” explained Rykard. “I found (a plan) that was really good for me. It actually cost $521 a month but with the (tax) credit that I got, I only have to pay $61 a month.”
Due to his income bracket he qualified for the new tax credit to help afford health coverage. The tax credit is immediately available to lower monthly premium costs.
The only downside for Rykard was that none of the plans covered dental or vision. These services were sold separately as add-ons. He saw this as potentially problematic for people like himself with diabetes because people are routinely expected to have their sight checked due to the nature of the illness.
“The only thing I didn’t like about the plan is they don’t cover dental. They don’t cover vision if you’re an adult. They only cover it for children,” said Rykard. “If you’re diabetic, you have to get your vision checked and you have to see different specialists and it doesn’t cover that either. You have to get that separately.”
The upside to the new healthcare law was repeated frequently by Leslie N. Burnell, senior community and program development specialist for Gateway Health. Through the new law, a patient’s Bill of Rights provides healthcare to those with pre-existing conditions, ends lifetime limits on health coverage, restricts annual dollar limits on coverage and so on. She also stressed the way doctors get paid through insurance companies would change as well.
“Doctors will be paid for quality of care. Now this is critical. In 2015 we’re going to see a different pay formula for your physicians,” said Burnell. “Doctors will be getting paid according to the quality of care they provide rather than how many people they see.”
Burnell said it is not entirely clear how a doctor’s “quality care” would be tracked, but she believed insurance companies would keep record through various claims made.
“I don’t know the whole science behind how that will be tracked but working for a health insurance company, I can pretty much say it will be tracked through claims. Medicare/Medicaid services will know, or the exchange insurances will know, how many times someone has gone to the doctor and for what. They will have people scrutinizing those records and that’s how doctors will start to get paid.”
A resident asked if doctors could reject insurance coverage from the “marketplace.” Burnell said they could.
“Yes that is true. Unfortunately, we can’t stop that. There are going to be some doctors that won’t take those plans just because of different restrictions and different expectations. Hopefully the doctors that we use already are good doctors and good people,” said Burnell.
Another challenge discussed was, unlike other states that have begun receiving federal dollars to implement the new health law, Pennsylvania has not received any federal monies since Gov. Tom Corbett has not expanded Medicaid and not accepted federal dollars. Instead Corbett has submitted an alternative plan he calls the “Healthy Pennsylvania Plan.” The state is currently awaiting approval of this plan by the federal government.
“What most states have done, is to take the federal money and expand their Medicaid programs so that more poor people would be eligible,” explained Rykard. “In Pennsylvania, the governor wanted to change that so the federal money that would come to the state, would (instead) go to help private insurance companies. Because he made up his own plan, he submitted that to the federal government which they are now reviewing.”
In the meantime, the March 31st deadline is approaching which Kirkland says has put Pennsylvanians in a precarious position and the state behind the “eight ball.”
“Unfortunately, our governor has not really embraced that fact that the Affordable Healthcare Act is important and right now we don’t have an expansion on Medicaid, therefore he is just now applying,” lamented Kirkland. “If you’re not insured by March 31st there could be penalties.”
Just last week, Crozer-Keystone Health System announced it was laying off 250 employees due to “… a slow start to the Federal Insurance Exchange. We have not seen the anticipated volume of patients signing up for insurance…” and in an open letter they stressed… “The federal government continues to decrease funding.”
Crozer-Keystone described the financial ramifications as “permanent, and they are affecting health systems across the country.”