New healthcare system poses challenges for some

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BIRMINGHAM, Ala. (WIAT) — Based upon what we’re hearing from UAB Health System and Blue Cross & Blue Shield of Alabama, there are some big opportunities and equally big challenges posed by the changes to health care.

David Randall, Senior Vice President of Strategic Planning and Business Development at UAB Health System says the health care law greatly increases access to health care coverage which is good, but that only increases demand.  Demand is only half of the equation.

“In the reform law itself there was nothing to address supply,” said Randall. “Probably the key challenge for us deals with increased demand. So we anticipate with the advent of the exchange more individuals are able to get coverage perhaps the expansion of Medicaid that we’ll see more demand particularly around primary care and maybe ambulatory care.

From that standpoint we’ve made a real push to increase our primary care capacity. So we’ve added I think about 10 physicians in the last year I think about 6 in the last 6 months and then we’re also looking at other care platforms like urgent care and maybe even the option of accessing some type of care online. So we’re looking at some different avenues to alleviate what that could, what that pent up demand may look like. There are also some opportunities though and they’re really around delivery, so how you treat patients.”

As far as the price of individual coverage plans, Blue Cross Blue Shield of Alabama says the premiums may be higher than they would have been in the past.

“The exchange products may be a little bit higher than what you see from your employer, but they may not be. that is why we suggest that you shop, you go out there and see what plans are available, what the benefits are, what the premiums are, for people who do not have coverage the uninsured, they also may be eligible for a federal subsidy depending on their income and that has the effect of lowering that premium in the amount that an individual may have to pay for that coverage, “said Michael Patterson, General Counsel, Blue Cross & Blue Shield of Alabama.

“If you’ve ever shopped for individual coverage before I think the plans that you will see during this open enrollment which began yesterday will be generally higher. The main reason for that is all the policies that will be sold during this open enrollment are guaranteed issued, meaning that an insurance company if you apply during the open enrollment has to issue you a policy even if you have a health condition.

So on par generally they’ll be a little bit higher than you have seen in the past if you’ve shopped for individual coverage before,” said Patterson.

There are only two companies represented on the Federal Exchange at healthcare.gov for the State of Alabama. They are Blue Cross & Blue Shield and Humana.

“Every insurance company in the country had the option of participating here in Alabama; to my knowledge Blue Cross Blue Shield only had one competitor on the exchange. I think for individuals looking for coverage they can go directly to Alabama Blue Dot Com to look at the offerings of Blue Cross Blue Shield of Alabama and they can go to our competitors website and look directly at their plans to see what the premiums are, what the benefits are what the out of pocket costs may be, copayments and deductibles to see if they can afford the kind of coverage that is being offered,” said Randall.

Open enrollment runs through March 31st 2014.

After that, “the only way you can sign up before the next open enrollment period in the fall of 2014 is if you have what they call a special enrollment event such as, I get married, I have a child, etcetera,” said Patterson.

Patterson says some employers are dropping spousal coverage from family plans if an employee’s spouse has the option of coverage from their workplace, but it’s too soon to tell if that’s a trend or connected to the Affordable Care Act.

“A health plan is an expensive benefit for all employers and I think annually they review the plan to see the cost involved and we have seen the last month some recent announcements primarily from national companies looking at the issue of spousal coverage and some deciding not to offer that coverage beginning in 2014 so it’s too early to say if it’s a trend, but I think definitely there have been some companies, mostly large national companies that have announced in the last 30 days that they are changing their spousal coverage,” said Patterson.

www.Healthcare.gov

 

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