Local providers say they're prepared for 'Obamacare'

Source: The Times and Democrat, Orangeburg, S.儲存C.Sept. 29--Local hospital and health care officials say they are prepared for one of the biggest overhauls of the country's health care system, but do expect some "bumbles and stumbles" as individuals begin to enroll for health insurance under "Obamacare" beginning Oct. 1."We know it is going to be a challenge but we can handle it," Family Health Center Chief Executive Officer Leon Brunson Sr. said. "We are prepared and have been gearing up for this for years."Under the Patient Protection and Affordable Care Act signed into law by President Barack Obama in March 2010, beginning Tuesday individuals who don't have job-based insurance coverage, who can't afford their own plan or have a health problem that previously got them turned down will all be able to purchase insurance on what is called the health care exchange or health insurance marketplace.Coverage begins Jan. 1 and open enrollment ends March 31, 2014. Individuals who don't have health insurance and can afford insurance after March 31, 2014 will face a fine.The ACA's goals are to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage and reduce the costs of health care for individuals and the government.The result will perhaps be more people using health services because more will be on insurance but exactly how ACA will impact health care usage is uncertain until the program kicks into full gear the first of the year."In the short term we are well staffed," Brunson said, laughing that "no one is totally excited about the work" but the FHC will survive.Brunson said the FHC has about 5,600 patients who come into its center from Orangeburg, Calhoun, Bamberg and Dorchester counties.He expects this number to triple to about 15,000 once the now-uninsured people in The T&D Region gain insurance. Brunson estimates that the FHC enrollment will double from 22,000 to 44,000 by 2016."If you have more paying people, you can't lose," he said.How much that will mean in revenues, however, is uncertain."This is hard to determine with the state of how Washington is right now," he said. "Washington does not know what it wants to do."Despite the uncertainty, Brunson says he is confident Family Health Center will grow as a result of the ACA."We are looking forward to it," he said. "We will expand and grow and offer more service lines by looking at vision care, behavioral health issues. We will be adding more providers and adding more access points and new sites."Brunson said one concern is the ongoing national doctor shortage. Will doctors be able to handle the expected patient influx?"We don't have that many doctors graduating from medical school today in South Carolina," he said. "There will be a major doctor shortage."He said the doctor shortage could result in some increased wait times for patients."You can't be prepared for every event that will happen," he said.Regional Medical Center President Tom Dandridge said the hospital is well prepared and has not even budgeted the ACA impact into its budget."Most people in the area have insurance through their respective employer," he said. The number of those patients will not change.RMC will be affected by South Carolina's decision not to participate in the Medicaid expansion, which was also part of the ACA.Citing a University of South Carolina study conducted for the S.C. Hospital Association, Dandridge said the RMC is expecting to see about $72 million in cuts from Medicare reimbursement and Medicaid and Medicare disproportionate share funds between 2014-2020.If the state agreed to the Medicaid expansion, the hospital would have been in line to benefit from $94.3 million in federal funding from 2014-2020."We are safe here," Dandridge said, noting some small rural hospitals in the state and nationally have already had to shut down due to the cuts in Medicaid."We have taken the cuts and have been aggressive in managing expenses. I think we are well on our way to do self storagehat," he said.Dandridge is confident the hospital will be able to absorb the cuts."We have a plan to provide more services like the Dialysis Access Institute and the expansion of the cancer center," he said.In the T&D Region, those most impacted by the failure to expand Medicaid are parents in low-income families of four making between $11,500 and $23,000 a year, childless adults making less than $11,000 a year and uninsured citizens ages 50 to 64.Dandridge estimates more than 12,000 people in Orangeburg and Calhoun counties, the two counties where most of the hospital's patients reside, fall into this category.Those poor and near-poor residents are likely to continue to be uninsured because the state declined to expand the Medicaid program. People below the poverty line will not be able to qualify for subsidies to buy coverage in the market. They will not be penalized for not buying insurance.Dandridge said the state did provide about $35 million in incentives for hospitals to steer patients away from pricey emergency room visits and to a "medical home" for those who will remain uninsured. Emergency room visits are considered one of the reasons for rising health care costs."We have identified people that have certain diseases like hypertension and diabetes who have no insurance and who have visited our emergency room at least five times in the last year," he said. Of the 400 people in that category, the hospital will have to find a primary care doctor for about 156 of them.Overall, Brunson said FHC patient sentiments are mixed as to the implementation of ACA."The ones who are educated are aware of it and are eager to sign up," he said. "Others have a little fearful attitude towards it because of what has been in the paper and what is going on in Washington and the confusion about government shutting down. We will educate our patients."Dandridge said he has not heard much from patients about the upcoming enrollment and does not know why."You wonder is it because they don't know or do they feel confident that they do know," he said.Dandridge said he hasn't heard much from doctors, either."They realize there will be frustrations for the first month or two on how to use it," he said.For example, he said that the calculator used to determine how much one's premiums and out-of-pocket expenses will be has some glitches.With only a few days before going live, Dandridge said he expects more of the same from the transition."Early on there will be some stumbles and bumbles with the exchange," he said. "With a six-month sign up period, I think they will work out the kinks. This is such a massive undertaking."Dandridge said the short time period to enrollment has concerned him because the hospital has not officially been able to train staff to help the public with the transition."We have done some self-education, but it would have been nice to have some training to know the finer points of how to use the exchange," he said.Dandridge said the hospital did apply to be a certified application counselor, but a call into the federal government has revealed its application is still in process."We will be happy to allow navigators to use the hospital," he said.Nationally, there are some concerns portions of the ACA are not ready for the official enrollment date. Small business and Spanish-language online enrollment services in federally run exchanges will not begin on Oct. 1 as planned but be delayed for at least one month due to technical problems.But Brunson said the FHC will make sure the local Spanish-speaking community will be served. The FHC will serve as a certified counselor site with trained staff to help people wanting to enroll."We will try to make sure we will be able to communicate with the Spanish population in our service area," he said.___Contact the writer: gzaleski@timesanddemocrat.com or 803-533-5551.Copyright: ___ (c)2013 The Times and Democrat (Orangeburg, S.C.) Visit The Times and Democrat (Orangeburg, S.C.) at thetandd.com Distributed by MCT Information Services迷利倉