Local health systems embrace Affordable Care Act changes

Some uncertainty remains on insurance reform, but industry readies for next step

CRYSTAL LAKE – When it comes to staying on the cutting edge of health care, Michael Eesley said embracing change is vital.

It is why Eesley, chief executive officer of Centegra Health System, and his colleagues have been making changes in the past few years in preparation for the implementation of the federal Affordable Care Act.

"I think it is something in our health system that we have put our arms around and really embraced," he said of the looming law changes. "It's different than what you have seen in the past. It is about total wellness in all areas for the patient, when it used to just focus on the inpatient side of things."

Hospitals and health care providers everywhere also are training themselves to educate people about the Affordable Care Act, signed in 2010 with provisions being phased in through 2020. Its intent is to make health care more accessible and affordable, and it requires most Americans to have insurance and businesses with a certain number of employees to offer it or pay a fine.

The Health Insurance Marketplace, or Exchange, is scheduled to open Oct. 1. It's a website that will serve as a central location for residents and small businesses to compare and choose from dozens of insurance plans. Coverage will kick in Jan. 1.

The policies will be divided into four levels – bronze, silver, gold and platinum – that offer different levels of coverage and services. The Exchange aims to get thousands of uninsured residents health insurance coverage; depending on income, some people will get subsidies to help offset costs, while others could be enrolled in Medicaid. Anyone can use the Marketplace to look for insurance, but not everyone will qualify for subsidies.

But for many health care providers, uncertainty remains about how the delivery and practice of health care will be affected by the Marketplace. Earlier this week, for instance, federal officials said the policies offered in Illinois and how much they will cost won't be available until the Marketplace opens.

Uninsured patients can be costly for health care providers such as hospitals. Danny Chun, spokesman for the Illinois Hospital Association, said there are 1.7 million to 1.9 million uninsured people in Illinois. The association represents more than 200 hospitals and health systems in the state.

Studies show that the uninsured tend to be sicker, put off care longer and can be difficult to treat as a result. Hospitals tend to be the first and last resort for many of the uninsured.

"They provide more than $1.5 billion a year for care which they do not receive any compensation," Chun said of Illinois hospitals.

Eesley said the new requirement for all individuals to carry health insurance would be a financial wash for Centegra and many health systems.

On one side, Eesley said, it would reduce the debt many health systems face when they provide care to the uninsured. But, he said, because more patients will be on low-cost coverage and Medicaid and Medicare, reimbursements will be lower and end up canceling the savings from the reduced debt.

The bottom line, he said, is more people will be covered and that is what is most important.

"If there is a mechanism for them to receive care, they will receive care," he said, adding that those on Medicare, Medicaid or other low-cost options would not be turned away. "We take great pride in maintaining all of our services at all costs."

Richard Gruber, vice president for Mercy Health System, said his concern is getting those who are uninsured to take advantage of the Marketplace. Individuals can opt to pay a fine that increases each year insurance is not purchased, so Gruber said it would be on health systems to educate patients about all the options.

"The ones who are uninsured today are likely going to be uninsured after Oct. 1 and when the new law starts," Gruber said. "We have done a lot of work with our financial staff to make sure we can let patients know all their options and work to get them a plan that works."

The IHA is encouraging hospital systems to consider applying to be Certified Application Counselor organizations, where a system's staff and volunteers help people understand, apply and enroll for coverage, according to an August letter from the organization.

Local agencies participating include Advocate’s Good Shepherd and Sherman hospitals, Centegra Health System, Family Health Partnership Clinic, Families ETC, Greater Elgin Family Health Center and Pioneer Center for Human Services.

Debra Quackenbush, spokeswoman for McHenry County Department of Health, said a community informational meeting on enrolling in the Marketplace would take place Oct. 2 at the Crystal Lake Public Library.

The unknown of how many people will be in what price range for health insurance has made it difficult on some health care providers.

Ginnie Flynn, spokeswoman for the Illinois Academy of Family Physicians, said there are mixed attitudes about the ACA among physicians, with many members in her organization not fully understanding how it will affect their work.

"Especially our younger members," Flynn said. "We even ask about the ACA to our medical students ... and the overwhelming response is, 'I'm not sure what is going on.'"

The concern is not as great at local health systems.

Ro Ostergaard, spokeswoman for Advocate Good Shepherd Hospital, said physicians would be paid Medicare rates for Medicaid patients under the health care reform – an important perk to encourage accepting all patients.

"This was meant to be an incentive for primary care physicians to accept Medicaid patients," Ostergaard said. "Moving an uninsured population to an insured population will benefit the patient in that they no longer have a financial barrier to receiving care."

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