Health Insurance Exchange System Just Around the Corner

BY KATHY KAHN

Hearts and flowers were put aside for a bit on February 14 as Suburban Hospital Alliance president and CEO Kevin Dahill got down to the nuts and bolts of the Affordable Care Act’s implications for Rockland.

Before a packed luncheon of Rockland Business Association members at Suffern’s Crowne Plaza Hotel, Dahill outlined the implications “Obamacare” will have on the county’s three hospitals, which are already seeing funding dwindling as ACA costs kick in.

The goal– to provide health insurance for 35 million uninsured and uninsurable Americans, with 1.1 million residing in New York – is admirable and needed, said Dahill. But to meet the costs of providing such care, hospitals nationwide will lose $156 billion in reimbursement over the next ten years. “This decline is already happening,” said Dahill. Physician reimbursements, too, are also part of the way the federal government will pay for ACA and have also been put into effect.

Rockland will see a loss of $22.4 million to its hospitals and another $13.5 million to its physicians over the next 10 years. “These cuts are taking place,” said Dahill, “even as Good Samaritan cut the ribbon on its new emergency room expansion this very morning.”

While much negative ado was made of the Affordable Care Act by former Gov. Mitt Romney during the elections, the healthcare system created under his watch in Massachusetts is now providing the guideline for other states to model their own healthcare systems.

From the federal government $400 million has been directed to New York’s Department of Health to ready the exchanges, and open enrollment is mandated to be in place by September, said Dahill. Since the insurance plan must have a minimum standard, Oxford’s EPO model was selected as a starting point in providing basic coverage.

“There will be ‘tiers’ that will offer varying levels of coverage,” said Dahill. “For people well acquainted with their medical needs and expenses, they will pick a plan with a higher premium that offers them the best coverage.” Others, especially the young and healthy, lamented Dahill, will opt for the cheapest plan with the higher co-pays and higher deductibles: It is not affordable if there is a catastrophic occurrence.

For the public about to embark on its journey into the world of Obamacare, “navigators” are being hired and trained to provide counseling assistance to those buying healthcare policies. “The goal is to create ‘one-stop shopping,’” said Dahill. “Navigators will determine if you qualify for Medicaid, Family/Child Health Plus or a small subsidy to help pay for your current insurance.”

Another sticking point for hospitals is an ACA policy that refuses to pay for a patient re-admission if it is within 30 days of a prior admission. “This is a battle we are going to keep fighting full force,” said Deborah Marshall, spokesperson for Good Samaritan. “What happens if someone comes in for surgery, leaves the hospital and gets hit by a car? He’ll have to come back to the hospital…how can anyone consider that a ‘re-admission’ when it is for something totally different than the first incident?”

Dahill is in full agreement. There is much that needs fixing in the 2,500 plus page document. “Congress changes, and we will see changes in ACA,” he predicted. “In the meantime, people need to be aware the health insurance exchanges will be here and in full gear by September.”

  Health Insurance Exchange System, obamacare, Rockland Business Association, Suffern