Illustration by Vivienne Lee
Virginians who receive insurance through Obamacare are in a bit of a muddle.
Yes, health insurance will be available for another year through the marketplace, beginning Nov. 1 for people seeking coverage through the Affordable Care Act. But with several providers from the previous year dropping out for 2018, many metro Richmond residents will have to scramble to find new plans.
The affordability of plans is also in question, as President Trump late Thursday announced that he wants to put an immediate stop to federal subsidies that have helped people in need pay for their health insurance. You can read about the potential impact of that move from the Washington Post here.
As it currently stands, coverage is available across Virginia, but in much of the state, there's only one provider. That's the situation in much of metro Richmond, where the only provider is Cigna Health and Life Insurance Co. Coverage also will be available through Anthem to residents of Goochland, New Kent and Powhatan counties in the metro area.
Several providers dropped out of the market for 2018 or severely cut back on their coverage area, leaving only Cigna in much of the metro Richmond market. HCA facilities and providers are covered through Cigna currently. Bon Secours and VCU Health are not in their network.
“That significantly restricts the choice of a patient, says Tony Herbert, vice president of managed care for Bon Secours Health System. Herbert in a telephone interview on Wednesday noted that you can go anywhere in the event of a health emergency, but otherwise you have to stay within your carrier’s provider network or they won’t pay.
VCU Health released a statement on Wednesday regarding potential impacts of the change: “Our biggest concern is for our patients, especially those with chronic conditions and serious illnesses, and how they can receive uninterrupted care with their current providers.” According to the statement, “As an academic medical center, our physicians often provide care patients can find nowhere else. We are committed to exploring all available options to maintain access to VCU Health services and to continue to serve all patients in our community. Patients affected by this change also have the option to research health insurance providers on the individual market off the exchange.”
HCA says it has been working with Cigna to prepare for the enrollment period. “For those patients experiencing a change in providers, we stand ready to coordinate their care through our multiple access points in Central Virginia — including seven hospitals, four free-standing ERs, five outpatient imaging centers and numerous affiliated providers. Above all else, we remain committed to continuing to provide high-quality, expert care for our community,” according to a statement provided Wednesday from Tim McManus, the president of the HCA Capital Division and senior executive for HCA Virginia.
Herbert says that Bon Secours is working with the marketplace and Cigna regarding transition of coverage, for example, coordinating the handoff on Jan. 1 for a patient who is undergoing cancer treatment at a Bon Secours facility but whose new marketplace insurance policy only covers care at an HCA facility. He says Bon Secours will “do what’s in the best interest of the patient.”
“Common sense will prevail,” he says. “We will reach some form of understanding.” Cigna in a statement today noted that information on its plans will be available through its website and through the marketplace website.
Help in finding and selecting coverage through the marketplace is again available this year through ENROLL Virginia. Open enrollment runs through Dec. 15, two weeks shorter than previous years.
“We have many challenges ahead,” says Jill Hanken, health attorney for the Virginia Poverty Law Center in Richmond. “We will do what we can to provide information before Nov. 1, and [consumers] can do some shopping and thinking about what plan to choose.”
The website is active, as is the marketplace website, healthcare.gov, but as of today there has been no posting of updated rates or information on 2018 plans.
About 360,000 Virginians received health care coverage through the ACA in 2017, according Hanken. People with coverage for 2017 under Obamacare should receive renewal notifications. Consumers should review the letters, and see if they can renew or must enroll with a new carrier. Even if there’s only one provider, there will be different levels of coverage available. Consumers should compare coverage options, and weigh such factors as costs, whether their physicians and preferred facilities are included, and look at the medication formulary to compare prices of the drugs they take. Coverage will begin Jan. 1 for plans selected during the open enrollment period.
After repeated failures to repeal or replace ACA this year by Republicans, the fate of the ACA after 2018 remains unresolved. Will the federal government continue to provide financial subsidies to the insurers, and to people who couldn’t otherwise afford coverage? Will the Republicans next year tweak the ACA, or will they find the votes to repeal the ACA and replace it with something else?
“I think what’s going on in Virginia just kind of reflects nationally what’s happening,” says Pete Cunningham, professor of health care policy and research at Virginia Commonwealth University. “We’re entering at least a year where there’s going to be uncertainty as to how the marketplace is going to function in the future.”
Herbert shares that sentiment: “It will be a very brave man who can predict what it will look like in a year’s time,” he says.
About 12.2 million Americans purchased insurance through the ACA in 2017, a drop of about 500,000 from the previous year. Many would not otherwise have insurance. Most Americans, about 154 million people, are insured through their employer; about 100 million are covered through Medicare and Medicaid.
Cunningham notes that uncertainty over federal reimbursement rates, or even if the federal government will continue the reimbursements, has affected the rates. Providers also have had to factor in the possible impact of fewer healthier, younger people buying coverage through the marketplace if the mandatory insurance part of the ACA is reversed or not enforced.
The mixed signals from Washington and the disruptions in coverage and uncertainties may lead to people leaving the marketplace and a decline in enrollment, Cunningham says.
“There is some concern for all the gains we’ve seen in health coverage, we might actually see a decline in coverage over the next year that reflects disruptions going on,” he says.
HEALTHY DEVELOPMENTS
A roundup of the week’s health and medicine news
- “When Life Gives You a Wheelchair, Make Lemonade” is the topic of a presentation by Zach Anner to be presented at 12:30 p.m. Monday at the University Student Commons Theatre, 907 Floyd Ave. Anner, who was born with cerebral palsy, is a comedian, actor and writer. He’ll also participate in a question and answer session and will sign copies of his book, “If at Birth You Don’t Succeed.”
- One of five small businesses will walk away with a $10,000 award on Tuesday, courtesy of UnitedHealthcare. The businesses are finalists for the company’s annual Community Care Award. They are: Aviant Health, BOHOCycle Studio and BHO Core, Lewis Ginter Botanical Gardens, Sneed's Nursery, and Woofy Wellness Ranch. Each will present a plan for a project that enhances community health or wellness on Tuesday to a panel that will convene at Simply Ballroom dance studio, the past year’s winner.
Michael Menen
Courtesy Bon Secours
- Bon Secours St. Francis Medical Center in Midlothian has a new chief medical officer, Michael J. Menen. He assumed duties in September and came to the post after three years as chief medical officer for HCA Chippenham Johnston-Willis. He is a member of the Richmond Academy of Medicine board and co-chairs its legislative committee.
- Work is underway on the HCA Johnston-Willis Hospital campus for construction of the Neuroscience Center of Excellence. The two story, 50,000-square-foot outpatient neurological services facility is set to open in summer 2018. It will include some physician practices and outpatient physical, speech and occupational therapy services for patients recovering from neurological conditions, according to a release. The projected cost is $10.5 million.
