Dr. Kevin Most: Cochran’s health scare and the ACA

Dr. Kevin Most on the Steve Cochran Show

Dr. Kevin Most joins the Steve Cochran Show to talk about the health scare that Steve had over the weekend.

 

ACA Bullet Points –

-We need to understand that Medicaid covers 3 Million Illinois residents, the change in the ACA may have bumped 650,000 off Medicaid and impacted how those patients care was funded.

-This keeps children under the age of 26 covered on their parents insurance plans, important to many of these individuals would be without insurance.

-The continuation also impacts the patients that may have been concerned with hitting annual or lifetime caps.

-The biggest is blocking the ability to deny insurance based on pre existing conditions.

-Changing plans and what is available

-Finding out if your doctor is on the plan you have available, or is the hospital in your plan

Any change in health care must be done in a thoughtful way and not rushed and pushed thru, it is complex and any changes should be well thought out. The next few months will be interesting for all the major insurers as they try to decide what to do as the uncertainty has impacted their planning.

Well, The Republicans could not muster up the votes needed to overturn the ACA with their plan. If you believe and understand all of the analysis, this is probably a good thing as estimates had the number of uninsured skyrocketing. So what happens with the status quo.

For one the individual mandate stays in place, in my opinion this is one of the tipping points. The only way any insurance works is those who don’t need the service support those who do need it. This is the same for home owners insurance, car insurance, disability insurance you name it. The ability for an insurance company to stay afloat is to make sure they have done their math correctly. This math is what actuaries do. Unfortunately as the ACA was rolled out the math did not work out. This is probably due to a few things, one the under estimation of the young healthy individuals who would take insurance instead of paying the penalty and also an under estimate of the number of ill individuals who did not have insurance in the past but then did with the ACA. These patients had pent up needs that stressed the finances of the insurance companies and coupled with the healthy individuals not taking the insurance was a disaster for many companies.

The impact of this is now being felt across the country. What is happening, well we all have heard about the dramatic increases in premiums. This is a concern as the premiums rise will the insurance stay “affordable”. Many individuals have a tough time with the premiums even with the heavy subsidy they receive. Any increase impacts them. They also are focused on the lower cost plans which have a high deductible, we know that many of these patients who can barely cover the premium certainly do not have the $5-6,000 for the deductible.

What other impacts are we seeing? The biggest is the decrease of insurance companies going into or staying in the marketplace. In some areas of the country we are seeing a marketplace that had multiple choices initially dropping down to 1 or 2 companies staying in. Some companies have actually gone out of business including one in Chicago. So in some areas it is essentially a monopoly and we know how well that works.

Probably the bigger impact to patients who are in a plan that is dropped. When this occurs the patient not only has to find a new plan but they also have to hope that their physician is in the new plan they choose. We are seeing more physicians limit the plans they are in, this may be based on the administrative costs, delay of payments or just overall difficulty dealing. In these cases the patient may now be forced to find another physician that takes their plan and also in the hopes that the hospital they receive care is also in the plan.

This impact is noted in not only primary care but in many cases the bigger impact is on the specialist care that these patients are receiving. Sometimes these changes result in the patient needing to travel great distances and change hospitals as well.

Hospitals also need to choose which plans they will participate in. This may be based on which physicians on their staff are in which plans, it also may be based on the quality of the plan. In some cases the hospitals are actually blocked from participating in the plan. In Chicago area, Advocate Health System has partnered with Blue Cross to design a plan that Advocate Hospitals are in but no other hospitals are.

So are hospitals happy that the ACHA did not go thru? For the most part, yes. A change had the potential to impact many individuals health and treatments. Hospitals and physicians want to have engaged patients. Patients who are concerned about their health and want treatment, we know that primary care done well with patients with chronic illnesses save money, extend life and more importantly increase the quality of life. Hospitals would have again seen patients with devastating illnesses present to their emergency rooms for care because they had lost their insurance or lost their physician.

The goal is to make sure we have insurance for all but more importantly the goal is that we can provide care in a cost effective way that slows the impact of chronic illness and that allows us to identify illness at an early stage when treatment is life saving and less harmful to the patient. These are short term goals or short term needs. In the long run we need to focus more on health of the community. We need to focus on preventing illness not how can we treat it easier. Adult onset diabetes could be cut back dramatically if we were able to focus on diet and exercise from childhood on. High blood pressure can be impacted with weight loss, diet restrictions and exercise in many cases.

The goal should be on how can we become a more healthy nation. If we can do that the cost of health care would be affordable for all.