The Clinton Herald, Clinton, Iowa

September 18, 2013

Affordable Care Act: Healthcare providers brace for the unexpected

By Charlene Bielema
Herald Editor

---- — Editor’s note: This is the third of a four-part series about the Affordable Care Act and its impact on the health care system. Monday’s article focused on the basics of health insurance, the law’s timeline, and what will happen when open enrollment goes into effect Oct. 1. Tuesday’s article featured a local program that will lead the way in reaching the uninsured to help them sign up and the services that will be provided under the law. Today, leaders of local facilities discuss the impact the law will have on health care service delivery.

CLINTON — With open enrollment into the health care system slated to begin in just a few weeks, medical facilities such as Clinton’s Medical Associates are bracing themselves for the unpredictability of what more patients will mean to health care service delivery.

Thomas Moser, Medical Associates’ chief operating officer, said that facility is preparing for the Affordable Care Act’s effect by actively recruiting more doctors to care for the influx of patients who will no doubt come through the doors as the result of pent-up demand.

But knowing how many new patients to expect still is up in the air.

“We don’t have a handle on what the numbers will be,” said Moser. “Nobody knows what the impact will be.”

Along with bringing in more doctors, Medical Associates’ urgent care facility that is now under construction will play a major role in providing services to patients who have not had insurance and who don’t have a doctor they see on a regular basis.

The new 6,000-square-foot facility will be located on the northwest corner of Manufacturing Drive and Valley West Drive. The facility will accept all major insurances, and will be price competitive with other primary care practices in the region, according to Medical Associates officials.

Unlike a traditional physician’s office, the new facility, expected to be open in December, will see patients without an appointment. It also will offer extended evening and weekend hours depending on the community’s needs.

By providing patients with care in a quick manner, Moser said the facility will fulfill a common expectation today’s patients have when seeking medical care — that of seeing a doctor as soon as possible.

While Medical Associates is getting ready to see more patients, Mercy Medical Center officials have been working with a statewide network to provide health plan products to Iowans this fall.

Six companies are set to participate in Iowa’s exchange, including two — CoOportunity Health and Coventry Health Care of Iowa, Inc. — that would offer coverage to individual buyers throughout the state. The other four companies will offer plans with regional limits or that apply only to group insurance.

CoOportunity Health and University of Iowa Health Alliance announced in July that they had been collaborating to introduce health plan products, with plan designs submitted to the Iowa Insurance Division for approval so they could be offered in the new Iowa Health Insurance Marketplace, the Iowa SHOP Exchange and in the open market for individuals and employer groups of all sizes.

Both health plan offerings — “CoOportunity Choice UI Health Alliance” and “CoOportunity Preferred UI Health Alliance” — feature a provider network that includes all member organizations of UIHA, including Genesis Health System, Mercy-Cedar Rapids, Mercy Health Network, which includes Clinton’s Mercy Medical Center, hospitals affiliated with Catholic Health Initiatives and CHE Trinity Health, Livonia, Mich., and University of Iowa Health Care.

This alliance of four entities includes more 50 hospitals and more than 160 clinics across Iowa with key locations in Des Moines, Davenport, Iowa City, Cedar Rapids, Sioux City, Dubuque, and Mason City.

“We believe this groundbreaking partnership is not only a unique opportunity for two new players in the Iowa healthcare landscape ― University of Iowa Health Alliance and CoOportunity Health ― to work together, but our collaboration means Iowans will benefit significantly from these unique health insurance options, particularly this year when the Marketplace opens for the first time,” said Dan Kueter, executive director of University of Iowa Health Alliance.

While not many details have been released on what costs will be for those who shop through the exchange, Insurance Commissioner Nick Gerhart has said premium prices on the state’s new health care marketplace will be lower in Iowa than on many other states’ exchanges.

In a news release, Gerhart provided some of the first details on the expected premium prices in Iowa.

”We have had a chance to see the rates published for other states on national reports. It’s clear that for comparisons of similar plans, Iowa’s rates will continue to compare very favorably,” Gerhart said in the release.

The Insurance Division did not release complete pricing estimates, but offered a few examples. A mid-range — or silver — plan for a 40-year-old nonsmoker in central Iowa would cost about $219 each month before any income-based tax credits were applied. That price was lower than many of the projections for similar plans listed in a recent report from the Kaiser Family Foundation, which looked at costs in the biggest city in 17 states, as well as the District of Columbia.

More detailed pricing information for Iowa should be released soon, said Insurance Division spokesman Tom Alger.

”It’s nice to have the deal sealed and to have firm knowledge that Iowans will have these choices, starting next month. Iowa has traditionally enjoyed having both a much lower-than-average percentage of its population uninsured and an average cost for health insurance that has been among the lowest in the country,” Gerhart said.

Under President Barack Obama’s health care overhaul, states must have a health care exchange, with enrollment starting Oct. 1 and coverage on Jan. 1. Iowa is partnering with the federal government for the exchange, where customers will be able to shop for coverage and qualify for subsidies and benefits.

The Associated Press contributed to this article.

Tomorrow: What to look for when shopping for a policy.