Despite political wrangling and bravado to repeal the Patient Protection and Affordable Care Act (PPACA) by lawmakers seeing red over costs and chaotic implementation, the health care revamp actually has been good for Arizona, according to multiple sources.
The state’s reality has more to do with the tenacity of Republican Governor Jan Brewer than anything else, although reducing government oversight, consulting the medical profession in decisions affecting its operations, and reforming liability dangle significant added impact.
Health care reform could get a boost, “if the new Republican Congress can get beyond trying to dismantle (PPACA) and fix the pieces that are not working well,” according to Dr. Joseph Goldberger, chief medical officer for Yavapai Regional Medical Center (YRMC). “They are creating more turbulence than benefits. It’s less efficient than letting people who do this for a living make the changes. It would be really nice if the [federal] government would back off the regulatory proliferation.”
Arizona Expansion
For her part, Gov. Brewer spearheaded enhancement of the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program. In 2012, 1.26 million aged, blind, and other needy Arizonans were covered under AHCCCS, per the Arizona Chamber Foundation.
One segment of the population, childless adults, was removed from AHCCCS by lawmakers in 2011, due to the state’s budget deficit. A major downside was that these childless adult Arizonans, then unable to afford medical treatment, showed up in emergency rooms with no money or insurance to pay the hospitals for care provided.
Gov. Brewer’s enhancement expanded the basic program to 133 percent of the Federal Poverty Level (FPL) – $11,170 for an individual and $23,050 for a family of four – as suggested under PPACA, and reinstated eligibility to childless adults.
To help the state control resulting costs, the governor’s plan established a statewide provider assessment on hospitals, designed to capture nearly $1.6 billion in federal funding during its first full year of operation, the Chamber Foundation reported.
“We are seeing a reduction in uncompensated care of several million dollars in our community,” Dr. Goldberger explained. “Part of the arrangement made was that hospitals would pay into the state fund so that the state would not have out-of-pocket costs. It’s spending millions to get millions. And, in the end, it’s a positive bottom line, even with that stipulation. That’s been one clear and very positive effect, and Gov. Brewer deserves credit for taking the hits she did to get that done.”
Sign Up Rate
Arizona is one of 27 states participating in the federal Health Care Marketplace. By April, 4,602 of an estimated 21,033 potential enrollees in Yavapai County had selected a Marketplace plan, according to the Henry J. Kaiser Family Foundation. That 19 percent, matching Arizona overall, compares to Vermont’s high of 87 percent and a low of eight percent in Massachusetts.
The PPACA is “really a combination of insurance reform and an attempt to gain some control over the rapidly rising cost of health care,” Dr. Goldberger said. “The downside is the whole insurance exchange and the narrow networks. It’s really variable as to whether your insurance costs are going down or up. But one thing that happens is that those going on the exchange, especially those not fluent in ‘insurance speak,’ might find themselves getting a product that underserves their needs (with) limited physicians’ networks and high deductible plans.”
In the November 2014 national Kaiser Health Tracking Report, 24 percent of those surveyed said the law had hurt them, 16 percent said it had helped and 59 percent reported no direct impact. Among those surveyed who said the law had hurt or both helped and hurt, increased costs were the most reported negative effect, while access to coverage and care were the top reasons given as helping. Among the hindrances cited were increased health care or insurance costs (15 percent), difficulty getting needed health care (4 percent), and someone in the family losing insurance (2 percent). The positives cited were allowing someone in the family to get or keep coverage (6 percent), making it easier to get needed health care (5 percent) and lowered health care or health insurance costs (3 percent).
While lawmakers deadlock along party lines, an individual’s perception of PPACA follows personal experience. A Quad Cities accountant discussed going from “being basically uninsurable” to “being treated fairly,” and saving $12,000 a year in routine medical checkups, testing and procedures.
Experience Rules
“There is a lot of positive stuff about Obamacare, but because this state is very Republican, people don’t want to talk about what their positive experience has been,” the accountant said. “Our insurance companies are there to make a profit… They [had] tightened the screws so much on the private market… Obamacare made all that go away and rightfully so.”
New help for YRMC is an Accountable Care Organization (ACO), a “big plus” touted by Dr. Goldberger, and a tenet of the PPACA. The concept he described involves shared savings via more comprehensive and economical care to a Medicare population. YRMC expects to be ready in January.
ACOs have been in place for some time, but YRMC “just jumped in the game this year,” he said. “Conceptually, it’s a very good stepping stone in trying to change the way we deliver health care in this country. It’s not smooth or easy, and it’s a very long process,” but one he predicts might be a “turning point when we look back” on health care reform.
Key Reforms
Dr. Goldberger identified three key areas for reform: medical research (especially pharmaceuticals), physician liability, and keeping reimbursements to medical providers in line with costs. With such reforms, research could ensure cost-benefits for new drug options, physicians could rely more on their own judgment versus worrying about additional testing and lawsuits, and providers could receive more appropriate compensation for services performed.
Dr. Goldberger, a private practitioner until June 2013, knows what it takes to run a successful medical office. “The individual practitioner is really struggling out there,” he said. “Reimbursements are not keeping up with costs. Regulations and administrative demands are taking up more and more time. That is why you are seeing more physicians joining large groups or the hospital network. It is so difficult to run a business and a health care practice.”
The U.S. health care system “really is critically dependent on the federal government getting it back together, rolling up its sleeves, and fixing the problems that are out there. We are all busy taking care of the requirements of the law, [employing] a huge amount of time and effort and money, and now there are questions about dismantling. You cannot run a business of any sort with this uncertainty.”
Dr. Goldberger said that the average person also has a role in health care reform by “becoming more engaged in their own health and well-being. Everyone thinks the solution is to take pills. That’s part of the process of keeping people healthy, but diet and exercise far outweigh any other individual effort that they could bring to the table… That is the real message to the public.” QCBN
By Sue Marceau
Quad Cities Business News