Health industry looks to preserve gains amid concerns about ACA repeal

MONICA NERONHA, vice president and deputy general counsel for Blue Cross & Blue Shield of Rhode Island, makes a point during Providence Business News' Health Care Reform Summit 2017, held Thursday at the Crowne Plaza Providence Warwick. PBN Editor Mark S. Murphy, left, moderated the panel, while other panelists included, from Neronha's left, Zachary Sherman, executive director of HealthSource RI, Dr. Peter Hollmann, chief medical officer of University Medicine Foundation and Peter Marino, president and CEO of Neighborhood Health Plan of Rhode Island. / PBN PHOTO/RUPERT WHITELEY
MONICA NERONHA, vice president and deputy general counsel for Blue Cross & Blue Shield of Rhode Island, makes a point during Providence Business News' Health Care Reform Summit 2017, held Thursday at the Crowne Plaza Providence Warwick. PBN Editor Mark S. Murphy, left, moderated the panel, while other panelists included, from Neronha's left, Zachary Sherman, executive director of HealthSource RI, Dr. Peter Hollmann, chief medical officer of University Medicine Foundation and Peter Marino, president and CEO of Neighborhood Health Plan of Rhode Island. / PBN PHOTO/RUPERT WHITELEY

(Updated: 3:50 p.m.)
WARWICK – As Congress tosses the hot potato of Obamacare repeal promises from hand to hand in Washington, health insurers, doctors and hospitals in Rhode Island worry about the effects of lost benefits and are focused on maintaining improved care and coverage that predates the Affordable Care Act.

Panelists at the Health Care Summit hosted Feb. 16 at the Crowne Plaza Providence-Warwick by Providence Business News did not pretend to know what to expect from the Trump administration’s promises to repeal and replace the 2010 Affordable Care Act.

But they pointed out how the federal subsidies that the state received through Obamacare and the improvements in health care – especially the emphasis on preventive and primary care – have improved the lives of many Rhode Islanders since the law was passed.

With help from low-cost and subsidized insurance policies provided through HealthSource RI, the state’s health-insurance marketplace, and expansion of Medicaid, more than 110,000 people in Rhode Island have health insurance today than they did in 2012, according to the state. Additionally, Rhode Island’s uninsured rate has dropped from 11 percent in 2012 to 4 percent in 2016. In all, 20,000 Rhode Island residents received health care subsidies.

- Advertisement -

Zachary Sherman, executive director of HealthSource, noted that health care coverage gets significant help from federal dollars. He said in 2016 the state received about $500 million in federal money via Medicaid expansion and $100 million via insurance-premium subsidies under the ACA (those figures are yearly averages under the ACA). Further, he said, 90 percent of HealthSource customers received federal subsidies and 70 percent of claims are covered by taxpayer money.

Sherman said Rhode Island enjoys a stable health-insurance marketplace and has seen premium rate decreases since HealthSource was created, because of market reforms that were underway even before 2010.

Monica Neronha, a health care reform expert who leads ACA implementation for Blue Cross & Blue Shield of Rhode Island, said it is unlikely that Congress would repeal very popular parts of the ACA, such as required coverage for pre-existing conditions and coverage under parents’ insurance for young adults up to age 26.

The most-threatened element of the ACA is probably the individual mandate, a thorn in the side of many Republicans. The mandate attempts to coax healthier people to buy insurance to help bear the costs of sicker people who need lots of care. That provision is flimsy, Neronha said, because “most people pay more out of pocket [for insurance coverage] than they would pay in penalties” for not being insured.

Neronha said Congress may consider “pulling out some of the sickest people and putting them in a separate risk pool.”

She compared Congress’ tinkering with plans for ACA revisions to Jenga, the block-stacking game, with planners carefully picking blocks out of the ACA structure without bringing the entire thing crashing down.

She said Blue Cross is advising insurers and customers to “stay the course” until repeal-and-replace plans coming from Washington become clearer.

Jay Raiola, a certified financial planner and member of the advisory board for HealthSource RI, said 90 percent of Rhode Island companies that employ 50 or more workers offer health-insurance coverage. Like Neronha, he counseled a wait-and-see posture for now.
Rhode Island has a strong and growing foundation of primary care, said Dr. Peter Hollmann, chief medical officer for University Medicine and a former medical director for Blue Cross. But he said the effects on patients of losing the benefits of the ACA could be dire.

“You will see people dying who didn’t need to die,” he said. “You will see people getting sick who didn’t need to get sick.”

The second portion of the summit focused on ways to control health care costs while maintaining and prioritizing quality care practices. The panelists established that much of the industry reforms should be focused on primary care, looking for new ways for primary care providers to deliver low-cost, cross-disciplinary health care services.

In addition, the pressure is on for businesses to foster a company culture of well-being and wellness.

No posts to display