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VOL. 6 | NO. 38 | Saturday, September 14, 2013

Open Enrollment Approaching for Insurance Exchange

By Michael Waddell

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With open enrollment for purchasing health insurance from the federally run Tennessee health insurance exchange set to begin on Oct. 1, local health care organizations are preparing with operational changes and plans for educating patients.

As many as 500,000 uninsured Tennesseans are expected to be eligible for insurance from the new exchange. Individuals and small businesses not eligible for employer-sponsored benefits can shop for coverage on the online market under open enrollment until March 31, and coverage starts on or after Jan. 1.

The Patients’ Bill of Rights explains people no longer will be penalized by insurance providers for having prior health conditions and no longer can be charged for having pre-existing conditions when they are signing up.

“The goal is to let people know that they should no longer have to pay high premiums that had been associated with their coverage up to now based on poor health conditions,” said David Elliott, vice president of managed care for Baptist Memorial Health Care Corp.

A total of only four companies have filed applications to sell individual insurance on the Tennessee exchange. Cigna announced in May that Tennessee would be one of only five states where the company would offer insurance via an exchange. And BlueCross BlueShield of Tennessee, Humana and Community Health Alliance of Tennessee (CHA) also will set up shop on Tennessee’s online marketplace, according to the Tennessee Department of Commerce and Insurance.

The companies are restricted from releasing any package or pricing details until Oct. 1.

Nonprofit CHA will be the only co-op operating in Tennessee, as it was the only co-op to get its application in by the end of the fiscal cliff. In May, Baptist Memorial Health Care announced a collaborative partnership with CHA to provide consumers with comprehensive patient-centered care.

“Most importantly, it will offer low-cost options for people looking for insurance,” Elliott said. “From a business sense, it will really help Baptist continue to grow and offer great providers and partners. It’s going to change our operations.”

The subsidized insurance will allow patients to go to any Baptist hospital or doctor, and hospital executives think it will help preventative care, allowing people to go to specialists like cardiologists more easily and affordably.

The hospital system plans to start with public education efforts about the new exchange on Oct. 1, since they are restricted by the government from beginning before then.

Baptist’s partner organizations will be charged with producing commercials and holding health-related Town Hall meetings, with the goal of educating people and helping to sign them up for CHA insurance.

“What the future holds we are not really sure because the co-op is set up as a nonprofit 501(c)(29), so technically it could be sold to a for-profit company, like an Aetna or Humana or Coventry,” Elliott said.

The Regional Medical Center at Memphis is currently in discussions with BlueCross BlueShield and CHA leading up to next month’s enrollment start date.

“We are in discussions with both companies to make sure we are on the panel to provide care for patients on the exchange,” said Dr. Reginald Coopwood, president and CEO of The MED.

Coopwood said he expects to have solidified some new partnerships by the start of October, and The MED is currently working on education strategies for its patients. The uninsured make up as much as 30 percent of The MED’s overall patient load.

“The whole uninsured community will not be covered by Jan. 1, but for those people within our organization that fall within the exchange population we will work to educate them and get them signed up so they can continue to receive uninterrupted medical care,” Coopwood said.

The Church Health Center has applied to be a certified application counselor organization, and some of its employees will complete 30 hours of training to become volunteers that will help sign up people with insurance from the exchange.

“We want to go that extra step to play a helpful role in our community accessing this care,” said Marvin Stockwell, Church Health Center communications director. “If we can help some of our current patients receive care elsewhere that just frees up capacity for us to help people who truly have no other recourse to care.”

The CHC handles 100 percent uninsured patients, while its Comprehensive Wellness Center serves the entire community without respect to insurance status.

CHC staff expects to see little drop-off in demand for their services, as it is estimated that 30 million people in the U.S. will still remain uninsured after the law is fully implemented in 2019.

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