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One Year In, Affordable Care Act Marketplace Hardly A Disaster

Protesters in Washington, D.C. speaking out against the Affordable Care Act in its early days.
Tabitha Kaylee Hawk
Flickr/Creative Commons

Today marks one year since the federal government started offering health plans under the Affordable Care Act on healthcare.gov, also known as the “exchange” or “marketplace.” The launch was rocky, to say the least, but for the most part the glitches and disasters have been cleared up, and the political battles have also exited center stage. What’s happening now is an unprecedented growth in the numbers of people covered in the Miami Valley—and a health care industry that’s booming.

About 157,000 Ohioans signed up for health plans through the federal exchange during the first open enrollment period, which ran from Oct. 1, 2013 into March, 2014. In January, Ohio expanded Medicaid under Obamacare to cover more low-income adults. More than 360,000 people have already enrolled around the state through that new eligibility. And most of the doom and gloom predictions about the Affordable Care Act haven’t come true. Premiums aren’t through the roof, and the website, pretty much works as the federal government prepares for a new round of open enrollment starting Nov.15.

“If I didn’t have Medicaid, I couldn’t survive”

Dayton resident Sharon Wood is one of the people who became eligible for Medicaid after the expansion. She had lost her job, and her insurance, and was doing temp work when something unexpected happened.

“I was driving home from a job and everything just looked white, I couldn’t see the cars.”

Wood, who’s diabetic, pulled off the road to clear up her vision. She went to the doctor and learned she was going blind.

“I went into a total panic. I came in here saying, I need to go to the eye doctor again, what do I do?” she said in an interview at Five Rivers Health Centers. The treatment to keep from losing her eyesight, treatments would be $50 every few weeks, money she didn’t have at all, living on social security. She had lost her health insurance after quitting a grocery store job to take care of her elderly mother several years ago. But early this year, Wood got Medicaid coverage; now she gets treatment for free at Five Rivers Health Centers. She can’t drive anymore, but her health is holding steady.

“I am able to continue to live on my own and be able to do the daily routines,” she says. “If I didn’t have Medicaid, I couldn’t survive.”

Choice and competition

People like Sharon Wood who have gone from being uninsured to Medicaid or marketplace plans under the new law are also entering health care with more choices; prescription drug coverage and coverage for specialty care means they can actually decide on the care that is best for them.

“This has really allowed us to do more for our patients, expand the options and even give them better care,” says Mamle Anim, the chief medical officer at Five Rivers. Most of Five Rivers’ newly insured patients are on Medicaid, although she says for those who are on new plans through the federal marketplace, the plans can be confusing.

But whether they are coming in with Medicaid or ACA coverage, more of Anim’s patients have the option to take their business somewhere else entirely, which means Five Rivers has to step up its game.

“We’ve always tried to do everything we can do for a patient, but right now we realize that if we don’t do it as fast as they need it or how they need it, they may go somewhere else,” Anim says.

Right now there can be a six-to-eight week wait for an appointment, so Five Rivers is expanding its family health center and increasing the numbers of same-day appointments so that patients can be seen immediately. This push to improve care is being duplicated around the Miami Valley as hospitals, clinics and private doctors see growing competition.

A shortage in primary care

Long waits are an issue all over: clinics, primary care, urgent care are all seeing more patients.

“We’ve definitely seen spikes in volume, and to try to combat that we’ve sort of been proactive and sometimes unfortunately reactive to increasing our staffing at all levels,” says Dr. Jennifer Hauler, medical director at the Huber Heights Emergency Department.

Kettering Health Network, which opened this stand-alone ER in Huber Heights three years ago, is ramping up staff and planning to open two more stand-alone ERs in Preble County and one in Springboro.

But ERs are just an entry point; a larger accessibility issue is looming with follow-up and primary care. Already today, Hauler says there aren’t enough family doctors or nurses and getting a follow-up appointment can take weeks.

Most people get financial assistance

Nationwide, around 8 million people had enrolled in plans through the healthcare marketplaces and exchanges by the end of the first open enrollment. Some exchanges are run by the states; others, like Ohio’s, are operated fully by the federal government. The exchange on healthcare.gov offers private health plans from a variety of providers, and then calculates government subsidies for the plans based on an individual’s income. People with incomes between one and four times the federal poverty level are eligible for subsidies; nationwide, 85 percent of new ACA enrollees got financial assistance.

CareSource, a Dayton-based Medicaid provider, was among 12 companies to offer ACA plans the first year; this year just one provider will back out, while five new companies will join the Ohio marketplace.

Scott Streator, the Vice President in charge of the exchange plans at CareSource, says the first year has been a windfall.

“Our enrollment doubled our projections,” he says. “We expected 15,000 and we enrolled 30,000.”

CareSource is expanding in downtown Dayton and Cleveland, and moving into Kentucky and Indiana; the company hopes to enroll a total of 100,000 in its ACA plans by the end of the new open enrollment period.

But Streator says there are still a lot of people who don’t know they could get subsidies, and CareSource’s market research has shown that affordability is one of the biggest obstacles to people signing up for care. Trey Daly with Enroll America Ohio says raising awareness about affordable plans is the organization’s big task for the coming open enrollment.

“There was and continues to be a high amount of misinformation or lack of accurate information about what is available through the health insurance marketplace,” Daly says. Enroll America conducted a survey that found many people aren’t aware they could get help, and the need for financial aid is a major obstacle to getting insurance. Daly adds that for people signing up for the first time, having an actual person available to guide them through it is paramount; Enroll America is working to get a hundred certified application counselors around the state, including bilingual counselors, to assist during the next open enrollment period.

Anyone making under 138 percent of the federal poverty level, or about $16,000 for an individual, can apply for Medicaid. Anyone making one to four times the federal poverty level, up to about $46,000 for an individual, can get some assistance through healthcare.gov.

Ohio Medicaid enrollment is open year-round. The three-month period of open enrollment in federal healthcare.gov plans starts November 15.

Lewis Wallace is WYSO's managing editor, substitute host and economics reporter. Follow him @lewispants.


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