Health care overhaul will bring better access to care, Meritus chief says

June 28, 2012|By JULIE E. GREENE |
  • Meritus Health President and Chief Executive Officer Joseph P. Ross
File photo

HAGERSTOWN — For the most part, the U.S. Supreme Court’s decision Thursday to largely uphold President Obama’s health care overhaul won’t result in any immediate changes for local residents.

But in the long term, it will lead to changes that provide better access to health care, according to Joseph P. Ross, president and chief executive officer of Meritus Health.

“We’re pleased with the decision,” Ross said of the Supreme Court’s ruling.

He said the federal health care law is “the most significant health policy legislation since Medicare and Medicaid.”

“There are without a doubt, thousands of people in Washington County who will be able to access affordable health insurance coverage because of the Affordable Care (Act),” said Joshua Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene.

The court’s decision “is a huge decision to ensure healthcare for many. This is the first step in ensuring that all Americans have the capability to get care when they need it,” Norman Epstein, president and chief executive officer for Summit Health, said in an email.

Summit Health oversees Waynesboro Hospital and Chambersburg Hospital in Pennsylvania.

“While we expect that the reform bill will reduce the number of uninsured, no one knows for sure how that will unfold at this time.  We will continue existing efforts to increase efficiency across the continuum of care, and focus more on prevention and wellness initiatives,” said a statement released on behalf of the chief administrative officers of City Hospital and Jefferson Memorial Hospital in West Virginia’s Eastern Panhandle.

“The Supreme Court ruling will not be the end of the health care reform debate. Hospitals will continue to face financial, operational and regulatory pressures that will continually challenge our hospitals and caregivers in ensuring that every West Virginia resident has access to ‘the right care, in the right place, at the right time,’” the statement said.

Once all of the federal health-care law’s initiatives kick in, every American still won’t have health insurance because some people will choose not to have it, Ross said.

“Those that just choose to pay the fine will still turn up in the ER and won’t have insurance,” Ross said.

There also will be many families who are so poor they will not be required to get health insurance, said Robin Roberson, executive director for the Community Free Health Clinic on Mill Street.

Among the millions of people who will be exempt from the requirement to have health insurance will be people whose incomes are so low they don’t have to file tax forms, according to the Kaiser Family Foundation’s website.

“From the standpoint of the Community Free Clinic, we continue to serve whoever needs our health care services, and we will continue to do that until we are forced to do otherwise,” Roberson said.

The clinic had more than 15,000 patient visits in 2011 and dispensed 44,079 prescription medicines worth more than $4.275 million, Roberson said.

There’s a huge demand for the clinic’s services, including from families making tough decisions about whether to put food on the table, pay utility bills, or pay for health care, she said.

Still, the federal law will help improve access and affordability of health insurance, health officials say.

Ross said he expects the number of visits to Meritus Medical Center’s Emergency Department to go up in the short term as people gain health insurance coverage, while the area still has a shortage of primary-care physicians.

Emergency department visits have increased about 6 percent to 10 percent a year. Ross said. The medical center could have close to 90,000 visits when the fiscal year ends Saturday or will soon have that many in a year, he said.

During the fiscal year that ended June 30, 2011, there were 72,575 visits to the emergency department, medical center spokeswoman Joelle Butler said.

“First, (the Supreme Court’s decision) means that there will be access to different insurances that we have not had before,” Ross said. “This is not as big a problem in Maryland because (the state) had good small market reform.”

Improved access
The federal law calls for states to set up new health insurance markets by 2014 in which residents can compare various insurance plan’s rates and benefits to find a plan that best suits them, according to  Maryland’s website.

If the state doesn’t create a new health insurance market, or exchange, the state has to participate in a federal one.

Maryland lawmakers have already passed a law calling for Maryland to operate its own health insurance market.

Sharfstein said the state is going to apply for a federal grant to pay to “construct” that market.

The state already has two health insurance options for Marylanders who are considered “uninsurable” in the private market, Sharfstein said.

Those options are an older state-funded Maryland Health Insurance Plan, and a federally-funded program the state started about a year ago after President Obama’s health care overhaul was approved, Sharfstein said.

The addition of the federally-funded program provided insurance for about another 1,000 Marylanders, Sharfstein said.

There are 339 Washington County residents enrolled in the older state plan and 24 county residents in the newer federally-funded plan, according to an email from a Maryland Health Benefit Exchange spokeswoman.

With the older state plan, participants pay about a third of the cost of premiums and the state pays the remaining two-thirds, Sharfstein said.

When the exchange starts, the federally-funded program will stop and the state-funded program will probably cease as well, Sharfstein said.

The federal law also calls for broader Medicaid eligibility starting in 2014.

People, between ages 19 and 64, and whose income is up to 133 percent of the federal poverty level will be eligible for Medicaid in 2014, according to a Medicaid fact sheet.

Based on the current federal poverty level, the new income eligibility level for Medicaid would be up to $14,856 for an individual and up to $30,656 for a family of four, according to the Medicaid fact sheet.

People whose income is between 133 percent of the federal poverty level and 400 percent of the federal poverty level, can get discounted private insurance coverage that will be subsidized with federal funds, Sharfstein said.

People whose income is more than 400 percent of the federal poverty level will not be eligible for a subsidy, he said.

Marylanders are expected to receive between $500 million and $1 billion a year in federal subsidies to help them buy health insurance coverage through the state-operated market or exchange, Sharfstein said.

‘Removes uncertainity’
“I think what this does is it removes some of the uncertainty and gives us a clear path forward to realign and ... restructure the health care delivery system to respond to this new major piece of federal policy,” Ross said.

Residents will “see no day-to-day, tangible difference in the health system, but this will set in place an evolution of change that focuses on managing health more than just treating disease,” Ross said.

Health officials could speculate on what to do when the Patient Protection and Affordable Care Act was passed in 2010, but couldn’t really plan with the uncertainty of its future, Ross said.

That planning will involve other health officials, such as public health departments, physicians, and nonprofit groups, Ross said.

Once Meritus Health figures out its response to federal health reform, that should help the health system recruit physicians to the local area, Ross said.

“You can define their place in the strategy,” Ross said.

Some of the planning Ross talked about included strategies to address obesity and social barriers, such as the lack of transportation, that keep some people from getting basic health care services.

It’s cheaper to help grandma get the $4 in medication she needs than have to pay for a $400 visit to the emergency department, he said.

The health system can’t take on a communitywide strategy alone, but can be an important player, he said.

Ross also stressed that people can keep their regular doctor.

Some people feared they would be forced into a health care delivery model in which they wouldn’t get to choose who their doctor would be, Ross said.

There’s been a lot of “political rhetoric” about the health care overhaul, he said.

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