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Hospitals, clinics brace for expected demand growth as ACA rolls out

Published: Saturday, Sept. 21, 2013 5:30 a.m. CDT

As Donna Cooper tells it, the team at Dreyer Medical Clinic has been preparing for Oct. 1 for quite some time.

Now, she said, the team only awaits the arrival of the first day of next month to know exactly how well prepared Dreyer actually is.

On Oct. 1, the federal government and many states, including Illinois, will open their health insurance marketplaces, or exchanges, in which Americans can compare and choose from various health insurance coverage plans offered by private insurers.

The exchanges will be opened under the provisions of the Affordable Care Act.

Federal officials and supporters of the ACA have said the exchanges could help millions of uninsured Americans, including thousands of local residents, obtain health insurance coverage.

But for many hospitals and health care providers, uncertainties remain about how they will be affected by the exchanges.

Hospitals and other health care providers have long noted that uninsured patients can be costly, pointing to studies that show the uninsured tend to put off care longer, and thus, are in worse health and more difficult to treat when they do seek medical help.

Danny Chun, spokesman for the Illinois Hospital Association, estimated there are 1.7 million to 1.9 million uninsured people in Illinois.

Generally, health care administrators said they expect the exchange’s impact to be positive, as more insurance coverage will spur more people to seek out health care services.

But they noted the rollout of the ACA provisions carries some unknowns, including how many people will purchase coverage and what kind of coverage they will buy. The types of policies and their costs likely won’t be known until the exchange opens.

Already, a number of large employers, including Walgreens, Home Depot and UPS, have indicated they will push some of their insured employees into the exchanges.

But the health care provider organizations have not yet been able to view the health insurance plans in the marketplaces.

“We don’t yet know enough about the plans that will be offered on the exchange,” Cooper said. “As soon as the information is released, we will be reviewing it closely to understand what the impact might be.”

But local hospitals, including Delnor Hospital in Geneva, Advocate Sherman Hospital in Elgin, Presence St. Joseph Hospital in Elgin and Presence Mercy Medical Center in Aurora, said the outcome could be positive.

Tammy Pressley, director of Community, Government and Public Affairs at Delnor’s parent company, Cadence Health, said enhancing access to health care “is of primary concern to use, not one specific plan versus another.”

“Even the lowest coverage is better than no coverage because it will remove some of the financial barriers to receiving quality care,” Sherman spokeswoman Tonya Lucchetti-Hudson said.

She said an ACA provision instructing Medicaid claims be paid at higher Medicare rates also will help, as it “encourages providers to accept Medicaid patients and may help to level the payor field over time.”

The hospital representatives also said they intend to help their patients navigate the insurance marketplaces once they open. Advocate and Presence noted their participation in the federal “certified application counselors” program.

“It’s going to be a major consumer education process,” Presence spokeswoman Barbara Fallon said.

Doctors and other health care professionals also still need to be educated regarding the provisions of the law.

Ginnie Flynn, spokeswoman for the Illinois Academy of Family Physicians, said there are mixed attitudes about the ACA among physicians. 

“Especially our younger members,” Flynn said. “We even ask about the ACA to our medical students ... and the overwhelming response is, ‘I’m not sure what is going on.’ ”

Health care providers have been preparing for several years for the changes wrought by the ACA, Chun said, working to find ways to “do things more efficiently.”

At Advocate, the system has hired case managers to work in doctors’ offices to help chronically ill patients without hospitalization, thus reducing costs.

And at Dreyer, the clinic has rolled out several initiatives to hold down costs, while increasing access to doctors. The efforts include “patient portals” that allow patients to track their health care history and needs, and the rollout of “e-visits,” in which patients suffering from common illnesses, like influenza, can be diagnosed and even prescribed medications by doctors via the Internet.

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