09/25/13 — Hospital official plans meetings to explain new health care law

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Hospital official plans meetings to explain new health care law

By Josh Ellerbrock
Published in News on September 25, 2013 1:46 PM

Despite concerns by federal politicians, Obamacare is moving forward -- and faster than some members of the public realize, a local health official said.

Wayne Memorial Hospital Chief Financial Officer Becky Craig spoke on the upcoming changes that go along with the Affordable Care Act as part of an educational series the hospital is conducting at various libraries around the county.

The idea is to share with the public what effect the new law will have on individuals and their health care coverage.

Some of the new requirements might surprise those who are not paying attention, Ms. Craig said.

"It is against the law to not have health insurance by Jan. 1," she said.

At the core of Obamacare, Ms. Craig said, are three primary goals -- to equip everyone with insurance, healthy or those with pre-existing conditions, and to give subsidies for those who may not be able to afford health care.

To do so, the federal government is opening up an exchange network of insurance providers that will offer more low-cost plans.

To get access to these plans, individuals must visit the Health Insurance Marketplace, an online site that Ms. Craig compares to a "Travelocity" approach to buying medical insurance. The website officially goes live on Oct. 1.

But not everyone needs to buy insurance from the Marketplace. If an individual is already covered by a federal program like Medicare or Medicaid, covered by an employer or already has an individual policy in place then he/she will not need to buy insurance from the exchange.

However, if an individual qualifies for a subsidy, then he/she can only access that subsidy through the Health Insurance Marketplace.

Right now, that could be a problem for Wayne County residents. Currently, only one insurance company is offering insurance plans through the exchange in North Carolina -- Blue Cross and Blue Shield of North Carolina. With the recent contract termination between BCBSNC and Wayne Memorial Hospital, anyone who will be covered by the exchange will have to pay higher rates than someone not covered by BCBSNC.

Ms. Craig said that Wayne Memorial Hospital has put a deal on the table with the insurance company to renegotiate the contract, stating that many of the company's concerns with Wayne Memorial -- high costs of treatment, low quality care -- are unfounded.

"We want to provide care to patients, and we want to do it and be financially viable," she said.

If negotiations don't result in a contract by Dec. 5, then Blue Cross members will have to pay more out-of-pocket money to access care at Wayne Memorial. Until that time, Blue Cross members will still be able to access care at Wayne Memorial.

If an individual does not have insurance by the end of Jan. 1, then the federal government will fine individuals through their tax returns. That rate for the next year is $95 per person or one percent of a household's income, whichever is higher.

Those fines will only go up through the next few years.

As for employers' concerns with Obamacare, they have a year of breathing room before it goes into effect. The act mandates that employers with more than 50 full-time employees or full-time equivalents provide an insurance plan to full-time staff and their dependents, or they will be required to pay a penalty.

After looking through the law, Ms. Craig has expressed support for the expansion of health insurance on both moral and financial grounds.

Emergency room visits from the uninsured sap $20 million from Wayne Memorial every year. By insuring the uninsured and getting them a primary care provider, preventative medicine can help curb the number of emergency room visits and save Wayne Memorial costs.

And it's better for the individual.

"There's no reason that people shouldn't have a doctor. With insurance, people are more likely to have a doctor. People who have health insurance live longer," she said.

Ms. Craig will do an Affordable Care Act presentation at the public library's Goldsboro branch Thursday from 6:30 to 7:30 p.m. She will hold a final session on Thursday, Oct. 10, from 6:30 to 7:30 p.m.