Health re­form law could lead to a new wave of un­der­in­sured

While health re­form is ex­pected to add 31 mil­lion to the ranks of the in­sured, low-in­come fam­i­lies—and providers— may still face sig­nif­i­cant fi­nan­cial risk

Modern Healthcare - - Front Page - Melanie Evans

Health re­form is ex­pected to ex­pand in­surance to mil­lions with­out it and of­fer house­holds more pro­tec­tion from the fi­nan­cial dis­tress of med­i­cal bills. But the law also leaves some newly in­sured vul­ner­a­ble to ex­penses that will add stress to al­ready strapped house­hold bud­gets, health pol­icy ex­perts say.

The law, which bans in­sur­ers from ex­clud­ing those al­ready di­ag­nosed with an ill­ness and caps the amount house­holds spend on care each year, does much to ex­pand pro­tec­tion for con­sumers from poli­cies that left pa­tients strug­gling to af­ford care, pol­icy ex­perts say. But, they say, for low-in­come, chron­i­cally ill peo­ple, the law may not do enough, and up­com­ing reg­u­la­tions on ben­e­fits could sig­nif­i­cantly af­fect how much pa­tients spend.

An es­ti­mated 24 mil­lion of the 31 mil­lion peo­ple ex­pected to gain in­surance un­der health re­form will do so through in­surance ex­changes—set to be­gin op­er­a­tions in 2014— that will reg­u­late the costs for low-in­come house­holds and off­set some of the fi­nan­cial bur­den with sub­si­dies, ac­cord­ing to the Con­gres­sional Bud­get Of­fice.

For hos­pi­tals, which have seen more in­sured pa­tients who strug­gle to pay med­i­cal bills, the push to ex­pand in­surance could bring with it newly un­der­in­sured peo­ple who are more likely than the in­sured to skip tests and med­i­ca­tions and less likely to seek fol­low-up care or see a spe­cial­ist.

Michael Miller, pol­icy di­rec­tor for Com­mu­nity Cat­a­lyst, a pa­tient ad­vo­cacy not-for­profit based in Bos­ton, says the law in­cludes pro­vi­sions that give con­sumers greater ac­cess to af­ford­able in­surance, but does not com­pletely achieve what many con­sider af­ford­able cov­er­age for low-in­come pa­tients— health­care costs less than 5% of in­come for those with in­comes be­low 200% of the fed­eral poverty level, or $21,660 based on 2010 guide­lines, and 10% of in­come for all oth­ers. “We didn’t get there,” he says.

A big bite out of the un­der­in­sured

Miller stresses that the law rep­re­sents a huge ad­vance from the sta­tus quo. Out-of-pocket spend­ing is capped and the lim­its are more re­stric­tive for plans sold to low-in­come house­holds within the ex­changes, he notes. “In that way, the law takes a big bite out of the un­der­in­sur­ance prob­lem,” Miller says. And un­der the law, in­sur­ers will be banned from set­ting a limit on the amount poli­cies pay in a year or over a life­time.

Jan­uary An­ge­les, a pol­icy an­a­lyst with the Cen­ter on Bud­get and Pol­icy Pri­or­i­ties, a non­par­ti­san pol­icy not-for-profit based in Washington, says the ex­pan­sion of cov­er­age alone will

St. El­iz­a­beth Health Cen­ter in Youngstown, Ohio, is part of Catholic Health­care Part­ners. Un­cer­tainty over health re­form’s ef­fects on rev­enue has af­fected the sys­tem’s plan­ning, ac­cord­ing to its CFO.

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