A gift or a lump of coal?

Last updated: December 13. 2013 10:50AM - 1837 Views
Civitas Media

Pediatric Nurse Practitioner Karen Martin examines Brayden Homer, 3, of Lima at Health Partners of Western Ohio
Pediatric Nurse Practitioner Karen Martin examines Brayden Homer, 3, of Lima at Health Partners of Western Ohio
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Sue Walker received the bad news in September from the insurer who handled her medical coverage in Jacksonville, Ill.

She was told that to meet the requirements of the Affordable Care Act, her premium would go from $513 a month to $890. She also would be required to purchase insurance that included maternity benefits, even though Walker is 64 years old.

Walker wonders how Congress could approve such a boondoggle.

Jacob Dicke, of Sidney, Ohio, will tell you quite a different story. The 28-year-old man is clicking his heels after learning he will be paying just $70 a month for health care, including dental insurance. The low rate is the result of one of many subsidies that are part of the Affordable Care Act.

Dicke couldn't be happier that Uncle Sam now has a national health insurance plan.

Welcome to the Affordable Care Act, nicknamed Obamacare, in honor of President Barack Obama's signature piece of legislation.

Everything you have heard about it is true, and everything you have heard about it is also false. The only thing that is really clear is that few things are really clear.

With a Dec. 23 deadline quickly approaching to ensure coverage for 2014, reporters from Civitas Media spent the past three weeks interviewing residents, business owners and health-care professionals in seven states, including Illinois, Kentucky, North Carolina, Ohio, Oklahoma, Pennsylvania and South Carolina. What they found is:

• People want to be informed, but it's hard for many to decipher the details or even compare plans.

• Not everyone has problems with the Healthcare.gov website. In fact, many find it easy to use.

• As the plan bites businesses, employees feel the pain.

• A private health-care system already clogged up by excessive paperwork may see the bureaucracy double.

The horror stories come from people such as Carla Watkins, of Pikeville, Ky., and John Keegan, of Hazleton, Pa.

Watkins, a 45-year-old nursing assistant, called her three hours on the website a nightmare.

"I was ready to scream by the time I was done," she said. "It's really going to put me in a financial bind now that I will be paying $92 more a month."

It took Keegan 10 days to finally gain access to the website.

"I tried three to six times a day, at all different times," he said.

And what he finally found?

"If I bought a plan, it would be approximately the premium I'm paying now. I would have much higher deductibles and co-pays," Keegan said.

Yet, Sue Stine, of Dallas Township, Pa., said she did the whole process in 20 minutes, going with a platinum plan that saved her $125 a month.

"It's better coverage. ... I'm also getting dental insurance, and it's still cheaper," she said.

What's in the law

When the Affordable Care Act was signed into law on March 23, 2010, it was touted as a way to provide affordable health care for millions of Americans. Among the guidelines required of all insurance plans:

• Eliminating lifetime or annual limits on coverage.

• Prohibiting refusal of coverage due to pre-existing conditions.

• Linking physician payment to quality of care provided (not in effect until Jan. 2015).

• Guaranteeing certain preventive services at no additional charge to the patient.

• Prohibiting dropping or limiting coverage due to participation in a clinical trial.

• Extending children's coverage under their parents' insurance plans until age 26.

• Monitoring premiums and insurance company spending.

Under the law, all insurance plans will have to comply to the above guidelines.

However, some grandfathered plans do not have to follow all provisions as strictly. According to President Obama, this is one part of the law that was intended to ensure Americans could keep their current plans if they were satisfied with them.

Recent problems have arisen that indicate the grandfather clause is not totally effective. Some people, whose plans do not comply with all of the guidelines, reported their insurance providers dropped their plans.

All of that has added up to a lot of confusion.

Business not as usual

John Springthorpe has watched SouthData go from a small document management company to one that now employs more than 100 workers in five states. With its headquarters in Mount Airy, N.C., it does everything from electronic and paper based billing to offering electronic and film based storage.

Springthorpe was succinct in describing the effects of Obamacare.

"For us, the impact has been one of frustration and confusion," he said. "We've seen our insurance costs go up at double-digit rates, and our insurance company finally, after months, admitted that it was due to Obamacare."

Springthorpe said he used to be able to use his quality insurance to lure talented workers to his company, "but it's become much, much more difficult in the environment we're in now."

One of the biggest frustrations for Springthorpe is larger corporations have been exempted from the requirements of the act. These exempted organizations include unions and even fast food chains, such as McDonald's and Jack In The Box.

"That's great for them, but it leaves all the focus of activity on those of us who for many years have tried to do what's right," Springthorpe said.

New requirements related to the act are also causing headaches.

"It's crazy," Springthorpe said. "For example, we're now required to send notices about insurance to the employees' home address instead of just putting it in with their paychecks. These are insane rules they're putting into place. It may sound simple, but we've had to create a new process, a new document and mail it out. It isn't enough that you do it, you have to be able to prove to the government you did it."

For Sherri Richardson, vice president of CCK Automations in Jacksonville, Ill., the learning curve also has been steep.

"I'm spending more time, along with my human resources manager, learning about the requirements that CCK has to meet," she said. "There is also more paperwork that needs to be handed out to employees. For instance, a health insurance application used to be two to three pages. Now, it's around 16 pages with all the forms and notifications."

CCK Automations, founded in 1999, is a printed circuit board assembly and industrial control panel manufacturer. The company has 47 full-time employees and has always offered health insurance for its employees, Richardson said.

"We used to pay 100 percent, but within the last five years, we have increased the employee contribution for insurance to 20 percent," she said. "Our coverage through Dec. 31, 2014, will stay the same with no great impact on cost either."

Her fear is for 2015, when "our insurance carrier is predicting a 40 to 50 percent increase in premiums due to Affordable Care Act requirements."

What makes it frustrating, she said, is "trying to adapt to the federal requirements when in reality we were already providing affordable healthcare coverage for our employees."

Catch 22 for hospital

Northern Hospital of Surry County, N.C., was recently honored by HealthGrades.com as one of the top healthcare providers in the country for general surgery and critical care. The hospital employs 800 full-time workers and another 100 workers on a contract basis. It offers 108 beds and sees an estimated 38,000 emergency patients and 5,000 admissions a year.

President and CEO Bill James said he is worried about the future in the wake of an influx of newly-insured patients that has yet to materialize.

That's just one problem.

A second hurdle was placed in James' path when North Carolina chose to not expand Medicaid coverage to offset the costs of the additional patients. The expansion would have increased the number of low-income residents who were covered under the program, with the state being reimbursed 100 percent through 2016, and at more than 90 percent thereafter.

"That changed the equation that had been laid out for us," he said. "Now there are several question marks and we just don't know what the end result will be."

Twenty-four states, including Oklahoma, North Carolina and South Carolina, refused to expand Medicaid. Illinois, Kentucky, Ohio and Pennsylvania plan to expand it.

Hospitals face a decreasing reimbursement even when someone does have insurance, said Mike Swick, the chief executive officer of Lima Memorial Health System. At a Rotary meeting in August, the leader of the 242-bed hospital in Lima, Ohio, noted Medicare pays 30 to 40 cents for every dollar a hospital charges, compared to around 50 cents from insurance companies.

"For those of you in business, how many of you would produce a product that costs $100 but routinely get paid less than that for the product?" Swick asked. "That cost is shifted to private insurance, and employers paying for health insurance, who can't afford it."

He said the real push should be on preventive healthcare and patients having a better understanding of what their care might cost.

When states declined to expand coverage for their most vulnerable residents, the result has been a one-two punch for hospitals' bottom lines. For James, the frustration is almost palpable.

"We thought we could anticipate patients who would finally have coverage, but at this time it's very unclear where that additional coverage will come from and whether it will come at all," he said. "We are carrying the burden of the down payment (for the implementation of the act) and are not realizing any benefit from it."

Waiting for the end game

Frustration has been a key word for many individuals as well.

Laura Minzer, executive director of the Health Care Council for the Illinois Chamber of Commerce, has probably heard it all when it comes to the Affordable Care Act.

She conducts informational seminars on the law throughout the state.

"People want to know, 'How's it going to impact me?' 'What's it going to cost me?'" Minzer said. "Overall, there is general confusion about what this law is and isn't. The fact is the ACA is complex and can be confusing. There is so much politicking involved that dissecting the truth and reality from the spin can be difficult."

Although there is a lot of complaining about the changes, many people will benefit, Minzer said.

"There were winners and losers in the system we had before ACA, and there are winners and loser post-ACA," said Minzer.

Richard and Debbie Hans, of Arcanum, Ohio, consider themselves among the winners.

"We plan to purchase health insurance through the new system once our current plan lapses," Richard Hans said. "It's a little less than what we're paying now. Our current plan was going to go up, but this will be lower and cover more. I had a pre-existing condition the other insurance wouldn't cover, so everything will be covered now."

Springthorpe, the president of SouthData, has a much different take. To him, it's pretty simple.

"It's like we're trying to figure out how to survive in spite of the government," he said.

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