Act expected to help cover inpatient care $45.9 billion in unpaid bills piled up on hospitals in ’12

Andy Ramos of Springdale was hospitalized late last year because of a laceration on his leg. Without insurance, he said he was stuck with the more than $1,000 bill.

“I had a job, but you have to wait a couple months before insurance starts,” Ramos said. “Then I got laid off.”

Hospitalizations will now be covered by insurance Ramos qualified for through the Patient Protection and Affordable Care Act. The insurance took effect Jan. 1.

“The insurance will help me out a little bit in case I get hospitalized again,” Ramos said while limping between aisles at the Springdale Public Library on Friday.

Inpatient care is one of 10 essential health benefits under the Affordable Care Act. All insurance plans that are not grandfathered in must cover the benefits. Grandfathered plans existed before March 23, 2010, and have not substantially changed. Plans offering the essential health benefits can be found on the state’s insurance exchange.

Karen Pollitz, senior fellow with the Kaiser Family Foundation, said inpatientrefers to admissions in the hospital. She said that in the past those without employer insurance could have had trouble receiving insurance with inpatient-care options through the individual marketplace because of pre-existing conditions.

Denial of coverage because of pre-existing conditions was also outlawed with the Affordable Care Act.

Ramos also has diabetes and has been hospitalized for low blood sugar because of the condition. He said he did not have insurance during those visits either.

Ramos said he has never looked into individual insurance plans. However, research conducted by the American Diabetes Association and Georgetown University Health Policy institute in 2003 and 2004 found that people with diabetes had trouble getting individual insurance because it was classified as a pre-existing condition.

A Kaiser Family Foundation report estimated that 114,532 people in the state had individual health-insurance plans in 2011. Another 131,248 individuals were enrolled in small-group plans,and an additional 521,500 people were uninsured.

Roxane Townsend, UAMS Medical Center chief executive officer, said eliminating insurers’ ability to deny coverage because of a pre-existing condition is “part of the beauty” of the Affordable Care Act.

“Our biggest issue is the amount of uninsured care that we provide,” Townsend said. “Thirteen and a half percent of our patients do not have insurance when they come to us. The advantage for us is that if a patient gets insurance there is now a mechanism for them to have their care covered.”

The hospital provides $64 million worth of free care annually, Townsend said. She said half of those costs are reimbursed through federal aid, but the hospital covers the rest. Sixty percent of the care is for inpatient services.

Another $77 million in freecare is provided by doctors and physicians’ assistants throughout the UAMS system, which includes regional centers, Townsend said. She said that care is not reimbursable.

The hospital has had 600 encounters with newly insured patients since Jan. 1, Townsend said.

“We can now expect payment from those insurance companies,” Townsend said.

She said the hospital expects to see more people with insurance over time because of the Affordable Care Act.

Hospitals in Arkansas on average had expenses of $1,451 per day when a patient was admitted into the hospital in 2011, a report by the Kaiser Family Foundation states.Expenses in Missouri were $1,998, in Tennessee were $1,541, in Mississippi were $1,166, in Louisiana were $1,563 and in Oklahoma were $1,573. The expense in Texas was the most at $2,001.

In 2012, hospitals in the country had $45.9 billion in uncompensated care costs,according to a report from the American Hospital Association. It states uncompensated care made up 6.1 percent of hospital expenses nationally.

Ellen Pryga, the association’s director of policy, said there are still a lot of unknowns about how the Affordable Care Act will affect uncompensated care that hospitals give.

“The change is the fact that coverage is being expanded to a wider range of individuals,” Pryga said. “We don’t know exactly what the compensation is yet. We don’t know for example the precise makeup of people who had pre-existing conditions and were uninsured because of that. We don’t know their age, what not. It should reduce uncompensated care, but there are a whole variety of things going on that could increase that debt.”

Pryga said the cost deductibles and cost sharing for the most affordable plans on insurance marketplaces created by the Affordable Care Actare a concern. Plans that have less insurance coverage at a lower cost fall into a “bronze” category on the insurance exchanges.

“They often have very high front-end deductibles,” Pryga said. “We may have an increase in the number of people covered. We also may have an increase to the debt because of high deductibles and high cost sharing.”

Deductibles in the insurance marketplace vary by plan. Premiums vary by an individual or family’s income. Federal subsidies are available for families or individuals making incomes of 400 percent of the federal poverty level.

The bronze category on the Arkansas insurance market has plans with deductibles between $2,500 and $6,300. The deductible must be met on all of the plans before co-insurance starts for inpatient care. Co-insurance coverage for inpatient care ranges from 0 to 5o percent on all of the plans with a majority offering 50 percent coverage.

Northwest Arkansas, Pages 7 on 02/10/2014

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