|Health care reform and you
Possibility of patient overload concerns experts
By Les O’Dell
The sweeping health care reform package – officially called the Affordable Care Act – passed last spring, was designed to overhaul the nation’s health care system and extend medical coverage to as many as 32 million Americans currently without insurance. With provisions set to take effect over the next few years, the impacts of the bill on rural health care providers and the patients under their care continue to be uncertain. Many analysts expect both positive and negative outcomes from the reform, while others are taking a wait-and-see approach.
Mary Jane Clark, President of the Illinois Rural Health Association and Manager of Health Resources for the Illinois Institute of Rural Affairs at Western Illinois University, says it will take years to see how the new regulations affect rural residents.
“I think there is a lot of speculation; people saying it will go this way or that, but it’s really not clear yet how this is going to impact all of us and what the trickle down will be,” she says. “It’s too early to get a handle on it.”
Many rural health experts in Illinois say whether the program is beneficial may depend upon the doctor’s office. Many say what initially may be good for patients, may not be agreeable to providers.
“The good news is the expansion of the coverage should encourage individuals to seek care as opposed to waiting until they are in a crisis,” says Rex Budde, President and CEO of Southern Illinois Healthcare, a regional provider with 20 facilities and three hospitals serving 16 predominately rural counties. “The bad news is the legislation doesn’t really impact the supply of physicians in rural communities in a positive way.”
In other words, it could make an already bad situation worse. Illinois already has a shortage of primary care physicians in rural areas according to Roger Holloway, executive director of the Northern Illinois University-based Rural Health Resource Services. In fact, 80 percent of the rural counties in Illinois already do not have enough medical providers.
He says even though Illinois medical schools rank in the top three in number of graduates, a majority of new physicians choose to practice in other states or go into more lucrative specialty practices.
“We in Illinois export a lot of doctors,” Holloway says. “Plus the number of graduates choosing to go into primary care is low.”
He says the result is rural areas are home to physicians who are older and fewer in number. Clark adds that those already-busy doctors now may face even bigger patient numbers and workloads.
“We had all of these people who did not have access to care before, and with an influx of people who haven’t seen a provider or haven’t had insurance, you’ll have people that are in the system for the first time and they’re likely to be sicker,” Clark says.
The flow of more patients into waiting rooms may spill over from doctors’ offices to emergency rooms.
“We will likely end up with additional insured patients coupled with a lack of adequate physician resources,” SIH’s Budde explains. “This means there’s no place for the newly insured to receive care except for traditional sources such as the local emergency room.”
Primary care physician Dr. David Kowalski of Effingham is concerned with what a higher number of patients could mean to others who need care.
“We have a moral and ethical obligation to take care of everyone; I took an oath,” he says. “We’re already booked for months, and now if we have to see more patients, we may not be able to see the critical care patients. We cannot allow the simple things to push out the critical care patients. It’s already happening in the emergency rooms; they’re taking care of colds and hangnails.”
Another aspect of the legislation includes efforts to reduce medical paperwork and increase the use of electronic medical records, commonly called EMR. The digital information contained in EMR can easily be distributed to multiple physicians and has many benefits.
“EMR will allow sharing of the same CAT scan, for instance,” Holloway explains, “so it will not be necessary to repeat it. My doctor can have at his fingertips all of my information from other physicians. That will reduce costs. In the end, you get a more streamlined approach to treating patients with the potential for the very best outcomes.”
However, Holloway adds, the push for adoption of EMR will not be painless. He points out that just 10 percent of all Illinois medical offices use EMR, with an even smaller share of rural practices utilizing the technology – a fact that further complicates efforts to attract new doctors to non-urban locations.
“When physicians come out of residency and they have gone through the entire medical training program with EMR, our chances of recruiting these physicians to places without it really diminish.”
As rural health care providers adapt to the new regulations, including the transition to computerized charts and records, some physicians anticipate their costs to increase.
“We will probably have to add another employee per physician because of the health care initiatives,” Kowalski says. “We face penalties if we don’t go to EMR, but if we don’t get any extra resources, it could become a major problem.”
He points out that he believes healthcare reform will empower more people than before to seek out medical care without really providing a means to pay for the care they receive. Plus, he says the delays in receiving reimbursements from state-run programs such as Medicaid magnify the problem.
“It eventually becomes an economic issue,” Kowalski says. “It could make my practice unsustainable.”
Budde says efficiency within medical organizations will be key under the new laws.
“One of the biggest challenges facing medical providers in the future will be the ability to do more with less resources,” he explains. “If costs exceed the original estimates, it is easy to see a scenario where the first place the government will turn to is further reductions in payments to providers.”
“Remember that these doctors are small business owners,” Holloway adds. “They have an obligation to provide care, but compensation has to be an issue. If we have a great increase in demand, but a reduction in payment, just imagine what will happen.”
Health care economist Paul McNamara of the University of Illinois says the reform has many positive aspects.
“The law is going to have some demand impact, but I don’t think it will be a catastrophe,” he says. “I don’t see an overloading of providers as one of the big problems.”
He adds the act could mean more dollars actually go to medical providers.
“A lot of rural providers already see a number of patients without any coverage and who have problems paying,” McNamara says. “This will help them have coverage so some of those bills will get paid by extending coverage. This should reduce the problem of providing care that is not paid.”
He says other aspects of the reform, including the establishment of health insurance exchanges in 2014 and the expansion of coverage to young people, should benefit people living in rural Illinois.
“The exchanges will create a place where people can get an offer of coverage with a level playing field. The options for getting insurance will be more transparent.”
McNamara added that the new law requires all companies with 50 or more employees to provide health care coverage and smaller businesses will earn tax credits in exchange for offering insurance to their employees.
“For some rural families who have struggled to get insurance, this will help them,” he adds. “I think it will benefit people who are not in Medicare or those that are self-employed or work in small businesses.”
Holloway says other provisions of the reform, including expansion of federally funded community health centers, also are beneficial to the rural parts of the state.
“The expansion of federal health centers will increase access to care and that’s good because these clinics provide a broader aspect of care than many primary care facilities,” he says.
More community care centers could mean an increase in specialized care and shortened travel times to see a specialist.
Good or bad, major changes in the nation’s health care system are coming.
“In the picture of health care policy, this bill is a big deal, a significant change,” McNamara says. “It will be interesting to watch how this will play out, because right now parts of it are not clear in what will happen.”
What’s the impact on electric co-ops?
Working for electric cooperatives can be hazardous, especially for line workers. Electric cooperatives have been able to provide affordable health insurance to employees and their families through the National Association of Rural Electric Cooperative’s (NRECA) Group Benefits Trust. The NRECA Group Benefits Program (GBP) already complies with many provisions of the law, and many other requirements that will impact co-ops do not take effect immediately.
NRECA throughout the health care reform debate worked with policymakers to protect the interest of electric cooperatives. One positive change was that the NRECA was able to get plans covering electric line workers classified as high risk, giving co-ops a higher threshold than most other plans before the 40% “Cadillac Tax” kicks in. Other positives NRECA supported were stronger incentives for wellness and chronic disease management programs, and reforms that prevent insurers from dropping coverage or excluding pre-existing conditions.
On the negative side are new fees and taxes levied across the health care industry on medical device manufacturers, drug companies and others that will simply be passed along to co-ops and other health care users. Also, while the new law significantly expands access to coverage for millions of Americans, it remains to be seen if it has done enough to change the trend of health care costs doubling every seven years.
It’s also important to remember that there is potential for changes to the application of the law as the government issues guidance and regulations. Changes also could result from legal challenges to the new law and actions of future Congresses.
For more information
Whether you have health insurance or not you can find answers to questions about the new law at the website HealthCare.gov. In addition to a section on understanding the new law there are sections on prevention, comparing care quality and tools for finding insurance options.
The Insurance Finder allows you to compare different plans, showing important information that has never before been made public. Price estimates for private insurance policies for individuals and families are available, allowing you to easily compare health insurance plans and taking much of the guesswork and confusion out of buying insurance. There are 299 health insurance companies represented with 8,500 plans available.
HealthCare.gov is bringing more transparency to the insurance marketplace – transparency that leads to more competition between insurers and better value for consumers.