Local health care administrators said the Affordable Care Act is giving more people health insurance coverage, but they still haven't been able to quantify the effect it's having on their facilities.
"It's hard to gauge," said Bill Bradley, Washington Regional Medical Center president and CEO. "I think some of our growth is because of the Affordable Care Act, but some is because of the area's population growth."
Affordable Care Act
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that began rolling out in 2010. Here are some highlights from the U.S. Department of Health and Human Services.
2010: A new Patient’s Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans.
2011: People with Medicare can get key preventive services for free, and also receive a 50 percent discount on brand-name drugs in the Medicare “donut hole.” The donut hole refers to a Medicare coverage gap.
2012: Accountable Care Organizations and other programs help doctors and health care providers work together to deliver better care.
2013: Open enrollment in the Health Insurance Marketplace begins Oct. 1.
2014: The Marketplace allows individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans.
Source: U.S. Department of Health & Human Services
Arkansas had 73,648 residents enrolled for a 2016 plan through the Health Insurance Marketplace by the Jan. 31 deadline, including 23,796 in Northwest Arkansas, according to the U.S. Department of Health and Human Services.
The U.S. Census Bureau reports Northwest Arkansas' population increased 7.7 percent between 2010 and 2014, from 465,699 to 501,653.
Bradley said Washington Regional's admissions grew 7-8 percent in 2014 and 2015 while the statewide average was 1-2 percent.
Sharif Omar, CEO of Northwest Health System, said the system saw a bump in insured patients in 2014, but that number leveled off last year. He said the system had about 10 percent growth last year in admissions and surgeries.
The focus now needs to be on the "hard-to-reach" population that includes people who are unaware of the choices or requirements, don't want coverage or face a language barrier, he said.
Additional people may get insurance in coming years because of an increasing penalty for remaining uninsured.
The tax penalty was the higher of 1 percent of household income or $95 per adult and $47.50 for dependents in 2014 and in 2015 jumped to 2 percent of household income or $325 per adult and $162.50 for dependents, capped at $925 for a family.
This year's penalty increases to 2.5 percent of household income or $695 per adult and $347.50 per child, capped at $2,085.
Omar said the Affordable Care Act has been a bit of a double-edged sword.
"We see less uninsured patients, but now we see a rise in bad debt -- people who can't afford their deductable and co-pay," he said.
Eric Pianalto, president of Mercy Hospital Northwest Arkansas, echoed it's hard to pinpoint the reasons for growth in services. He said Mercy has seen a shift away from bad debt and charity care because of the Affordable Care Act. President Obama signed the act in 2010, and provisions were rolled out over the next several years.
"We were already taking care of a lot of those patients, and now we are seeing some payments," he said.
Dr. Steve Goss, president of Mercy Clinic Northwest Arkansas, said a goal of the Affordable Care Act is to get patients out of emergency rooms and into doctors' offices.
Pianalto said Mercy's emergency room has someone on staff who helps patients schedule clinic visits.
"The goal is to reduce costs while improving quality," he said.
Jason Wilson, Medical Associates of Northwest Arkansas CEO, said the biggest change at medical clinics is who is footing the bill. MANA is a physician-owned network of 77 physicians and 21 clinics.
"We're also seeing patients who haven't had insurance and have multiple issues," he said.
Omar said there is a move away from a fee-for-service system to one that looks at the entirety of a patient's care.
Part of that plan for Northwest is creating a clinically integrated network with the Sparks Health System based in Fort Smith and the Siloam Springs Regional Hospital. The three systems are owned by Community Health Systems.
A clinically integrated network connects providers, such as physicians and hospitals, to manage care by sharing information on things such as prevention strategies, acute treatment and ongoing condition maintenance. The goal is to improve the overall health and well-being of the community.
Omar called it population health management and said the program will allow everyone to see each other's key data points. The health systems have been designing the program for about 10 months and hope to implement the multimillion-dollar investment in the coming months, he said.
"The decisions we make now have an impact today, but we are setting up for the future," Omar said.
The health care law has not been implemented without some negative impacts, Bradley said. Washington Regional cut 27 positions in 2014 and implemented a pay freeze that ended last year.
"For every $3 cut, we've been able to get about $1 back," he said. "I do think as far as access goes, the Affordable Care Act's been successful."
Mercy Health laid off about 350 employees last year, and leaders at the time blamed the Affordable Care Act, budget cuts and Medicaid reimbursement issues as reasons.
The system has more than 40,000 workers in 46 hospitals in Arkansas, Kansas, Missouri and Oklahoma, including the Northwest Arkansas facilities.
NW News on 03/27/2016