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Thu, Feb. 27

Marketplace insurance changes leave all in ‘wait-and-see’ limbo

Changes to the Health Insurance Marketplace landscape are possible, leaving no one knowing yet what that will look like.
Courier file photo

Changes to the Health Insurance Marketplace landscape are possible, leaving no one knowing yet what that will look like.

PRESCOTT – In the evolving health care and insurance arena, Yavapai Regional Medical Center leaders say they are taking a “wait-and-see attitude.”

The election of Republican Donald Trump and an all-Republican Congress could mean radical changes to the Health Insurance Marketplace landscape, but no one yet knows what that will look like or when it might unfold, YRMC and other medical industry officials have stated.

What YRMC officials can affirm is the hospital will make no changes in its commitment to providing the very best health care to each and every one of its patients, regardless of their insurance coverage.

YRMC events

Yavapai Regional Medical Center financial counseling and workshop sessions to assist people with the open enrollment period for the Affordable Care health marketplace that has a deadline of Jan. 31, 2017.

Events at the YRMC West campus admitting area, 1003 Willow Creek Road. For information, call 928-771-5151.

• Saturday, Dec. 10: 8 a.m. to noon.

Events at the YRMC East campus admitting area, 7700 E. Florentine Road, Prescott Valley. For information: 928-771-5151.

• Monday, Nov. 21: 5 p.m. to 8 p.m.

• Saturday, Dec. 3: 8 a.m. to noon

• Wednesday, Dec. 14 – 5 p.m. to 8 p.m.

If you are unable to attend any of these events, feel free to schedule an appointment.

Despite the unknowns and potential financial impacts, YRMC Chief Financial Officer Lee Livin said the hospital administration has no plans to raise prices to reflect changes in the Affordable Care Act.

“What we charge patients will not be impacted at all because of the ACA,” Livin emphasized. “It didn’t affect us when it went into effect, and it won’t affect it as the ACA evolves.”

YRMC has been, and will remain, the “community’s health provider,” said Ken Boush, the hospital’s director of marketing and communication.

The most troubling impact Livin sees with Arizona’s Health Insurance Marketplace – the state’s response to the Affordable Care Act colloquially known as Obamacare – is patient cost. With only one provider for much of Arizona, including Yavapai County, Livin said price-shopping no longer exists for what people might consider an affordable health care package.

Blue Cross and Blue Shield of Arizona is to be the sole marketplace provider for 13 of 15 counties, and its rates increased by 51.7 percent on average for all of its individual plans, ranging from catastrophic plans to the highest cost plan that provides 80 percent coverage. As an example, the range of monthly premiums for a family with non-smoking parents 40 or older with two children go from $1,000 for catastrophic coverage only to $2,729 for the highest level of coverage.

Federal subsidies on premiums do reduce to as low as zero what some consumers must pay for their plans based on family income, but state Department of Insurance officials are clear that one-fourth of marketplace consumers are not eligible for any federal subsidies. Some local residents have said their plans are likely to cost them $1,500 or more per month.

For those who might opt to risk no insurance, the Affordable Care Act imposes a penalty imposed through the income tax process of $695 per individual, or 2.5 percent of a household income, whichever is higher.

Livin predicts there will be many who opt to take the gamble.

As of two years ago, marketplace consumers had almost a dozen insurance companies with plans they could select to meet their insurance needs, the competition driving costs and offering multiple options suitable to meet individual income and health needs. With insurance companies pulling out of the Marketplace because of financial losses suffered as a result of their consumer base demanding higher cost services than anticipated, 2017 will be a year when consumers will be unable to price shop. These are individuals who do not have employer health plans from which to choose, and are neither eligible for Medicare or Medicaid insurance coverage.

Those higher costs are going to force some people to take risks with their health, Livin suggested. Even if they do get insurance, some will take the more affordable plans with high deductibles, avoiding doctor’s visits and preventive screenings rather than be faced with those co-payments, he said.

The consequences for those who risk no insurance, but then experience some type of catastrophic illness or injury, are bills they may not be able to afford.

YRMC offers financial assistance plans for those without insurance, or whose insurance falls short of covering a particular bill, but the burden remains on the patient to cover those expenses, Livin and other officials said. The impact on the hospital for those who refuse to pay those bills remains to be seen, but Livin and others in the health industry say it is something medical providers cannot ignore.

Legal costs alone could escalate as doctors and health institutions seek reimbursement for their services, industry officials predict.

“Our preference is that everyone have insurance, no question about that,” Livin said.

Another issue that may impact the hospital, and their physicians, is people coming to them sicker and in need of more expensive care because they opt against preventive care with their own doctors. YRMC and most medical professionals endorse preventive care, including routine cancer screenings and diagnostic procedures, to keep their costs down and enhance quality of life for patients, Livin said. Without insurance, though, to cover those costs, some patients may simply opt not to do them, he said.

YRMC Director of Revenue Cycle Services Jason Metcalf is optimistic that fears over Blue Cross and Blue Shield of Arizona as the marketplace’s sole provider prove unfounded. He said it may be that they prove a trusted insurer that exceeds patient expectations.

On the Medicare front, Metcalf said those patients will still have a variety of options even though Phoenix Health is no longer offering Medicare Advantage plans.

Regardless what happens, though, YRMC will continue doing business, and remains committed to helping its patients, and the community, navigate whatever comes, complete with financial counseling and workshops, said Ken Boush, the hospital’s director of marketing and communications.

“We’re doing the best we can to work with people … as we always have,” he said.

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