Providers still waiting to see effects of ACA

By Christina Calloway

ccalloway@pntonline.com

With New Mexico Health Insurance Exchange sign-ups moving slowly, hospital administrators and health care providers say they have yet to see the effects of the Affordable Care Act.

With the exception of cuts to the Medicaid program, officials said the ACA, enacted to expand affordable health insurance to uninsured New Mexicans and Americans, hasn’t had any real effect on the volume of patients they see.

“I think there’s potentially a plus and a negative,” said Plains Regional Medical Center Administrator Hoyt Skabelund. “I don’t think the smoke will have cleared for about two years.”

With the expansion of Medicaid in the state, which began Oct. 1, the state’s Human Services Department Director of External Affairs Matt Kennicott said more than 90,000 residents have been enrolled.

The insurance exchange has not seen a boom because enrollment deadlines have been repeatedly delayed due to the technical difficulties with the rollout of Healthcare.gov, Kennicott said.

Skabelund said the situation has hurt the hospital financially because Medicaid reimbursement money was cut to hospitals on Jan. 1. Because of these delays, the number of insured people the hospital is seeing is still low, he said.

Skabelund added that New Mexico already receives some of the lowest payments for Medicaid in the country.

“President (Barack) Obama has delayed the mandate for individuals yet he has not delayed the payment cuts. Now you’re delaying insurance you promised would offset the payment cuts,” Skabelund said. “If everyone has insurance than hospitals won’t have as many losses, so the logic is they don’t have to pay as much. The negative side is the hospital payment cuts. We’re going to cover more people.”

Roosevelt General Hospital President Larry Leaming said his hospital continues to see uninsured patients, noting that many are reluctant to sign up with the exchange.

In regard to the Medicaid expansion, Leaming said he can’t tell if it’s the expansion or a bad flu season that has kept the hospital’s emergency room and clinic tied up this season.

Leaming said time will tell what effects the ACA will have on the hospital.

“No one knew what to expect,” said Leaming of the ACA rollout. “If the uninsured people in the state could get coverage as it was designed to do, that would be a wonderful thing. For those people, most of that is unsubsidized.”

Leaming said what started out as a great idea ended up in regulation and bureaucracy.

“It becomes so complex that it’s lost the original idea,” Leaming said.

Leaming said RGH cannot turn away indigent patients, so that group finally has a shot of getting coverage.

But Leaming said it won’t work if the insurance company payments don’t cover the cost of care. Leaming said just because insurance companies are part of the exchange does not mean hospitals have to accept contracts with those companies.

“We’re not going to sign the contracts if they can’t pay us for what we need to do,” Leaming said. “We’re hoping that the insurance companies will come back with a decent contract at a decent price.

Skabelund said there is concern among PRMC’s staff.

“Nothing has happened according to what was originally planned,” Skabelund said. “We know change is coming and we’re trying to figure it out.”

Skabelund said his staff has noticed patients are confused and frustrated with the exchange.

Skabelund said doctors are also seeing patients with higher deductibles delay care, such as surgery.

Skabelund added PRMC has experienced a substantial decline in its overnight patient care, and fewer patients admitted to the hospital, but the number of emergency room patients remains steady.

For La Casa, CEO Seferino Montano said about 40 percent of the patients they see — about 7,200 — people, are uninsured.

Montano said his staff assumes at least 70 percent of that pool will be able to become insured or covered through the expansion. But he agrees with other providers that with sign-ups being delayed, it’s too early to tell.

Montano said La Casa clinics have remained stable in volume. Outreach workers at La Casa have been busy signing up patients for insurance with the assumption they will be retaining those patients, he said.

“When it’s all said and done, people who have never had insurance will at least be able to have a sigh of relief that if something catastrophic happens, ‘at least I’m covered.’”By Christina Calloway

ccalloway@pntonline.com

With New Mexico Health Insurance Exchange sign-ups moving slowly, hospital administrators and health care providers say they have yet to see the effects of the Affordable Care Act.

With the exception of cuts to the Medicaid program, officials said the ACA, enacted to expand affordable health insurance to uninsured New Mexicans and Americans, hasn’t had any real effect on the volume of patients they see.

“I think there’s potentially a plus and a negative,” said Plains Regional Medical Center Administrator Hoyt Skabelund. “I don’t think the smoke will have cleared for about two years.”

With the expansion of Medicaid in the state, which began Oct. 1, the state’s Human Services Department Director of External Affairs Matt Kennicott said more than 90,000 residents have been enrolled.

The insurance exchange has not seen a boom because enrollment deadlines have been repeatedly delayed due to the technical difficulties with the rollout of Healthcare.gov, Kennicott said.

Skabelund said the situation has hurt the hospital financially because Medicaid reimbursement money was cut to hospitals on Jan. 1. Because of these delays, the number of insured people the hospital is seeing is still low, he said.

Skabelund added that New Mexico already receives some of the lowest payments for Medicaid in the country.

“President (Barack) Obama has delayed the mandate for individuals yet he has not delayed the payment cuts. Now you’re delaying insurance you promised would offset the payment cuts,” Skabelund said. “If everyone has insurance than hospitals won’t have as many losses, so the logic is they don’t have to pay as much. The negative side is the hospital payment cuts. We’re going to cover more people.”

Roosevelt General Hospital President Larry Leaming said his hospital continues to see uninsured patients, noting that many are reluctant to sign up with the exchange.

In regard to the Medicaid expansion, Leaming said he can’t tell if it’s the expansion or a bad flu season that has kept the hospital’s emergency room and clinic tied up this season.

Leaming said time will tell what effects the ACA will have on the hospital.

“No one knew what to expect,” said Leaming of the ACA rollout. “If the uninsured people in the state could get coverage as it was designed to do, that would be a wonderful thing. For those people, most of that is unsubsidized.”

Leaming said what started out as a great idea ended up in regulation and bureaucracy.

“It becomes so complex that it’s lost the original idea,” Leaming said.

Leaming said RGH cannot turn away indigent patients, so that group finally has a shot of getting coverage.

But Leaming said it won’t work if the insurance company payments don’t cover the cost of care. Leaming said just because insurance companies are part of the exchange does not mean hospitals have to accept contracts with those companies.

“We’re not going to sign the contracts if they can’t pay us for what we need to do,” Leaming said. “We’re hoping that the insurance companies will come back with a decent contract at a decent price.

Skabelund said there is concern among PRMC’s staff.

“Nothing has happened according to what was originally planned,” Skabelund said. “We know change is coming and we’re trying to figure it out.”

Skabelund said his staff has noticed patients are confused and frustrated with the exchange.

Skabelund said doctors are also seeing patients with higher deductibles delay care, such as surgery.

Skabelund added PRMC has experienced a substantial decline in its overnight patient care, and fewer patients admitted to the hospital, but the number of emergency room patients remains steady.

For La Casa, CEO Seferino Montano said about 40 percent of the patients they see — about 7,200 — people, are uninsured.

Montano said his staff assumes at least 70 percent of that pool will be able to become insured or covered through the expansion. But he agrees with other providers that with sign-ups being delayed, it’s too early to tell.

Montano said La Casa clinics have remained stable in volume. Outreach workers at La Casa have been busy signing up patients for insurance with the assumption they will be retaining those patients, he said.

“When it’s all said and done, people who have never had insurance will at least be able to have a sigh of relief that if something catastrophic happens, ‘at least I’m covered.’”

Speak Your Mind

*