Local health care providers are bracing for an increase in insurance claims next year when almost 800,000 Georgians must enroll for coverage, according to the U.S. Department of Health and Human Services.
Barbara Corey, senior vice president of managed care for WellStar Health System, said so far their network has not seen a bump in the amount of patients seeking treatment.
“In January, we will get a better sense of what the real impact will be,” said Corey, who has been with WellStar since 1999.
Georgia’s number of uninsured residents is the fifth highest in the nation, amounting to 1.9 million people, according to Amanda Ptashkin, an Outreach and Advocacy Director for Georgians for a Healthy Future.
Residents without health insurance for more than three months in 2014 may have to pay a fee of 1 percent of their yearly income or $95, whichever is higher, according to www.healthcare.gov, a federal government website managed by the U.S. Centers for Medicare and Medicaid Services.
The amount increases every year, so by 2016 the fee is 2.5 percent of income, or $695.
Residents who have an individual insurance plan, are covered by an employer, use Medicare or Medicaid or are provided health care through active duty military or veteran programs are compliant with the new federal Affordable Care Act.
Corey said plans being created to address the Affordable Care Act are similar to insurance policies that already exist, with the major questions from WellStar’s billing department being where to send the claims and what services need preauthorization.
Gap remains for uninsured
There are “hardship exemptions” under Obamacare for uninsured residents with very low incomes. But there remains a gap of 500,000 Georgians, who make too much to qualify for Medicaid but can’t afford to purchase private insurance policies.
Ptashkin said an individual would have to make less than $12,000 to qualify for Medicaid, and a family of four would have to make less than $24,000.
Under the Affordable Care Act, each state has the option to expand Medicaid, but Georgia and many other Southeastern states like Alabama and Mississippi have not expanded the program so far.
Ptashkin said if the Medicaid program is not expanded, then there will continue to be a strain on Georgia’s health care system by uninsured emergency room visits, and residents will continue to not treat their health problems because of high prescription costs.
The number of uninsured patients has continued to rise for several years, said Corey, who estimates about 13 percent of patients across the WellStar Health System are uninsured, which is an increase from eight or nine percent four years ago.
Corey said there could be an increase in the number of patients treated in the WellStar Health System if more people become insured in 2014. But, she predicts WellStar will actually maintain a similar number of patients who will now use insurance instead of paying out of pocket.
“(Patients) will be more likely to come in for things they might have delayed when they weren’t insured,” Corey said.
Any increase in the amount of health care services sought by the public will depend on if a patient understands what is covered by their plan and how much their deductible is before their insurance kicks in, Corey said.
The Affordable Care Act gives a comprehensive list of the type of treatment that must be covered by an insurance plan, such as doctor visits, lab work, hospital stays, emergency room services, maternity care, prescriptions, mental health services, substance abuse treatment and preventative screenings for high cholesterol or types of cancer, for example.
Corey said WellStar provides a full spectrum of services, including preventative care the network promotes through community outreach events, such as health fairs where free biometric screenings are available.
“I think it is a very exciting crossroads in health care in America today,” Corey said. “I think it is pushing health care to be more patient-centered. A lot of good can come from it.”
The “tremendous opportunity” to possibly treat more patients will require WellStar to continue expanding their network to meet the needs of the community, Corey said.
Corey’s role in the managed care department will be to sort through new federal regulations and try to anticipate any unintended consequences that might come from the Affordable Care Act.
Ptashkin said the biggest change is that no one will be turned away from insurance companies for having a pre-existing condition, which she said will help asthma suffers and Georgians with high blood pressure.
“Everyone is guaranteed to get a plan,” Ptashkin said. “That peace of mind is really critical.”
In the past, Ptashkin said health insurance companies have been able to deny people for these conditions or raise the rate to be covered.
“Price will no longer will be based on health status,” Ptashkin said.