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Health care law: Providers unsure of coming effects

February 28, 2013
dsp By JOSELYN KING and SHELLEY HANSON - For The Times Leader , Times Leader

WHEELING - Wheeling Health Right Executive Director Kathie Brown said she and other health care providers don't yet know what effect the new health care law will have on current medical programs.

But she is certain there will be a continued need for free and reduced-cost health care offerings, and Wheeling Health Right will continue to exist.

The organization on 29th Street in Wheeling provides free comprehensive medical care - as well as preventive care and pharmaceuticals - to those who can't afford it.

Article Photos

Photo/Joselyn King
Clorisa Price, left, an LPN at Wheeling Health Right, and Katie Hall, a medical assistant, prepare an examination room for the next patient.

The government expansion of Medicare is set to begin at the start of 2014.

"Even by 2019, it's expected there still will be 12 million to 15 million people uninsured," Brown said. "There will still be a place for us - we may just have to change our look."

Wheeling Health Right has been certified by the National Accreditation Board as a provider of quality health care services, and the new health care law requires physicians and health care institutions to partner with such qualified providers, she explained.

Doctors and hospitals still will need to refer patients to Health Right who don't have adequate health insurance, and they also must work with a group to help educate the community about preventive health measures, Brown continued.

She said there also will likely be a contract relationship between Wheeling Health Right and local medical professionals in which Wheeling Health Right would be reimbursed for providing care for needy patients.

"To get higher reimbursements, they will need us," Brown commented. "They will have to establish a relationship with us."

In 2010, the U.S. spent $2.6 trillion on health care, an average of $8,402 per person, according to information compiled in May 2012 by the Kaiser Family Foundation. That figure compares to $6,868 per person in 2005, and $4,878 in 2000.

In 1970, the cost per person for health care was just $356, the foundation found.

Some other key findings of the Kaiser report include:

And as health care costs rise, so do insurance premiums.

Health insurance companies across the nation have received approval to raise their rates this year, with some hitting nearly 40 percent, according to healthcare.gov.

While it's easy to believe the rate hikes are due to the Affordable Care Act, one company said that's not the case - at least not yet. Dave Mathieu, spokesman for the Health Plan of the Upper Ohio Valley, said his company raised its rate by an average of 10.73 percent because its costs have increased due to the region's aging population.

In other words, elderly people tend to use more health insurance than those younger. In 2012, the Health Plan raised its rates by 8.5 percent.

''Our medical costs continue to climb,'' Mathieu said. ''Our membership is fairly stable. ... But in our geographic area we're not getting a lot of young people into the workforce.''

He said the national health care law had little impact on the rate, which is figured by an independent actuary. For 2013, the company's only reaction to the law was charging $1 per enrollee per year, he said.

Additional changes, he added, are coming in 2014 when companies will charge more to compensate for being charged extra taxes and fees by the federal government.

For example, one fee is related to the government-run state health care exchanges. If a company wants to participate in the exchange they will be charged a 3.5 percent user fee.

The Health Plan, like most insurance companies, will pass this cost on to its customers, Mathieu said. Another example for 2014 comes when the Health Plan will charge another $5.50 per enrollee per month to prepare for having to pay out more for people previously considered too high risk or ''uninsurable.''

While most companies' rate increases ranged from 10 to 20 percent this year, Mathieu believes the higher increases, such as Celtic Insurance Co. of Chicago's at 38.92 percent, are by companies that sell insurance to individual users, not groups. He believes those extra high rates are those companies' way of preparing to have to pay out more for the previously ''uninsurable.''

Jason Butcher, West Virginia Insurance Commission spokesman, said a company's rates may vary state to state because of the previous year's financial results.

''Insurance companies don't make their money off premiums, they make their money off investments. ... They can't lose money,'' Butcher said. ''That's how their rates are driven - by loss.''

 
 

 

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