Making care great again?

(Sarah Pridgeon) CCMSD CEO Nathan Hough stands in the hospital gym, part of the district’s push to increase wellness services. Though the initiative was not necessarily a direct result of the ACA, he says, many of these services are more readily accessible to a larger number of patients thanks to the increase in insurance coverage.

As feds push ACA repeal, CCMSD considers local impacts

By Sarah Pridgeon

On his first day in office, President Donald Trump signed an executive order calling for federal agencies to begin “easing the burden” of the Affordable Care Act (ACA), otherwise known as “Obamacare”. Many took this as a sign that Trump supports sweeping changes to the program that altered how millions of Americans manage their health insurance – but what those changes will be, nobody yet knows.

“I don’t know that anybody has really seen any plans on specifically what they’ve got in store for us,” says Nathan Hough, CEO of the Crook County Medical Resources District.

“One consistent thing that I’m seeing in all the coverage is that everybody agrees we can’t just do away with the ACA without having some sort of plan in place to replace it. What that plan looks like, I have no idea, but the ball has started rolling in enough areas that it’ll be really tough to just pull the plug on it and not have that be detrimental to a lot of people.”

While clear that any change made to the ACA will impact everyone, whether the law is repealed entirely or given an overhaul, Hough says it’s far too early to predict those effects with any certainty.

“I think the mistake people make is in the assumption that, if ACA goes away, it’s going to go back to the way that it was a few years ago. I think there are too many pieces to the ACA to have that be a reality,” he says.

Wyoming could be better off than many other states if the new administration pulls the plug on Obamacare, he continues, because the state chose not to expand Medicaid to catch those patients who fell into the coverage gap. It’s not at the state or even hospital level, however, that he believes the changes will be felt most strongly.

“I think the impact is going to be more on the patients and their risk of coverage,” Hough explains.

“I would say there would be a population that was uninsured, maybe similar to or worse than what it was before. I’m afraid that it might even be a little worse than it was before in terms of uninsured lives.”

Hough is also uncomfortable at early suggestions to remove the ‘guaranteed coverage’ clause.

“Maybe it’ll give the insurance companies the option to dump some of these people who are sicker,” he says. “They are the ones who make me nervous because they’re the ones who use it and really need it.”

As with the HIPAA laws that govern patient privacy, Hough points out, there are many parts of the ACA that form its bedrock and are not actually on the dashboard of options a patient sees. It’s possible that substantial changes could be made to the system that the end user never really notices.

Whatever happens, says the CEO, the district’s role is to ensure it adapts to the situation as it unfolds and remains ready to provide care to the community.

The Story So Far

Three years after the Affordable Healthcare Act became law, it has had a noticeable impact on the overall healthcare system. Implementing the system has not been smooth sailing, with only one insurer on Wyoming’s health insurance marketplace for 2017 and reports of premium increases up to seven percent this year that, according to the Casper Star Tribune, has been attributed to more people than expected making use of medical services.

So how did the ACA change things for our own rural healthcare district?

Uncompensated Care: Hospitals tend to support the ACA because more insured patients means fewer unpaid accounts, says Hough, which in turn means less lost revenue. “We saw a small decrease in our charity care – we are seeing more insured lives,” he confirms.

Awareness of Options: Forcing every American to consider health insurance has had the knock-on effect of making more people take a close look at their options, Hough says. “I think there is a population out there that was probably Medicaid eligible once they got checking on getting insurance or moving away from the insurance they had available through their job. I think they took the initiative to find what else they might qualify for,” he explains.

Lower Care Costs: For an uninsured person, visiting the doctor can be expensive. Providing more people with insurance means they are more likely to visit their healthcare provider rather than wait for a problem to escalate. “Somebody who doesn’t have insurance will avoid the doctor and avoid the doctor until they end up in the emergency room. What turns into a $1000 visit could have been handled as a $100 visit,” Hough says.

More Appointments: With more insured people, says Hough, there has been an increase in the number of patients visiting their doctors for non-emergency appointments. “I think we have seen a change in that with the volumes that we’ve got,” he says.

Preventative Care: More insured people has also led to more interest in preventative programs and education on wellness, says Hough. “People are taking more initiative in staying healthy so, if nothing else, I think it’s raised awareness in the general population about what’s available to them and what they can do to combat their high-cost healthcare,” he explains.

Identifying Health Issues: Education and wellness options are open to everyone, says Hough, but the ACA has assisted in identifying the patients who actually need it. “Patients have to have it identified somewhere along the line that they need it,” he says. An uninsured patient who is pre-diabetic, for example, may choose to ignore the symptoms; with insurance, they may be more likely to seek an examination and tackle the disease before it becomes life-threatening.

Hidden Costs: There are some extra costs for citizens and insurers associated with the ACA, says Hough, but he believes most of these have been positive. For example, there are costs associated with expanding coverage for dependents up to the age of 26, he says, as well as changes to the guidelines on how many hours an employee must work to be eligible for full coverage.

Quality Control: On the shirt-tails of ACA is a pay-for-performance initiative that rewards a healthcare provider for good performance or docks payment when standards are not being met. This has pushed rural hospitals to focus on their strengths and improve their care in those areas, says Hough.

Transparency in Pricing: Another ACA-related measure, this has allowed people to shop around a little more for the best care, Hough says. “I’m all for that, and when we look at our prices here I want to make sure that we’re consistent with the region and competitive,” he nods. “If we make changes, it’s one of the legs of the stool that we’re going to look at.”