The Oct. 1 start of enrollment in health care exchanges may be the most visible part of the Affordable Care Act so far.
But changes to insurance and health care nationally already are about something other than lowering health care costs or widening access to health care and health insurance coverage.
“I think for most people, they assumed that this was all about providing care for the poor,” said Church Health Center founder Dr. Scott Morris on the WKNO-TV show “Behind The Headlines.” “What I think people will find jaw-droppingly unbelievable is that at the Church Health Center, which sees effectively 100 percent of our patients working and uninsured, 80 to 90 percent of our patients it will have no impact on whatsoever.”
That’s because so far, the impact is on health care exchanges and doesn’t involve a Medicaid expansion.
Tennessee Gov. Bill Haslam initially said no to the expansion, which would be funded fully by the federal government for the first three years and then be 90 percent federally funded for three years after that. Haslam has been negotiating terms for an expansion since initially turning it down.
So health care exchanges – whether federal or state – apply to those who are at least 138 percent above the federal poverty index.
“If you’re a single individual and you make less than $16,000 a year, or you are a family of four and your income is less than $32,000 a year, when you go to the exchanges and you pop in your data, what will come back is that you will get nothing. The poorest people get nothing,” Morris said. “The assumption was absolutely that every state would expand Medicaid. … So if you are working in a near-minimum-wage job, you’re going to have to pay full bore, same as you would today, for health insurance. And they just can’t afford it.”
Dr. Richard Thomas, a consultant to several local hospitals, estimated 25,000 to 30,000 Memphians without health insurance could be covered through the exchange. And he added that if the state had taken the Medicaid expansion, the uninsured with access could have increased by another 80,000.
Thomas said the Affordable Care Act has made some difference with adult children remaining on their parents’ insurance and payments of several hundred dollars each to consumers from insurance companies who in the past did not allocate 80 percent of the premiums paid them to health care costs.
“Really this has been an insurance overhaul, not a health care overhaul,” he said. “Most of the changes, most of the provisions, focused on insurance coverage.”
Morris says the far bigger change to Memphis’ health care landscape so far is hospitals buying physician practices. He said few patients realize that shift is underway and that it might mean their health care plan no longer allows them to see their current doctor.
“Who does your doctor work for now? Your doctor used to be an independent contractor,” Morris said. “Within two or three years, 80 percent of all the doctors in Memphis will work for one of the hospitals. They will be employed physicians. … It’s about insurance. It’s about the formula that will soon endeavor to take up how doctors and hospitals will be paid.”
Thomas said the idea of hospitals buying medical practices has been tried before.
“Hospitals didn’t understand the process of running physician practices, despite the fact that they do employ certain types of physicians. Running outpatient care is a lot different from running inpatient care,” he said of the previous efforts.
Among his clients now is Methodist Healthcare, where he has seen a different approach that is playing out nationally, in which hospitals are moving away from places where the focus is on the number of beds.
“They’ve got this notion of a hospital without walls,” Thomas said of Methodist. “We’re no longer talking about bricks and mortar. We are talking about a system.”
In some way though, Morris said, it is a system that is frustrating to patients, including an exception he saw recently at Church Health Center – a woman with an income level that probably qualified her for coverage in the federal health care exchange.
“I tried to sell this, saying, ‘I think you won the lottery in some ways. This is a great thing for you,’” he recalled. “Her response was, ‘I make $10 an hour. Here are my bills. This is not free. Yes, I may get a discount and subsidies from the government, but it’s still going to cost me $150 a month.’ I’ve never had this happen to me. She got angry at me talking about this.”
“Behind the Headlines,” hosted by Eric Barnes, publisher of The Daily News, can be seen on The Daily News Video page, video.memphisdailynews.com.