The federal health care exchange went active Oct. 1, as uninsured Americans nationwide could enroll in affordable health care plans that go into effect as early as Jan. 1. However, health care industry officials in South Montgomery County still are not sure what effects the Affordable Care Act could have on the local industry and the community.
"The law itself is 2,000 pages long and they're producing already 15,000 pages of regulations," said Steve Sanders, CEO of Memorial Hermann The Woodlands. "It's very difficult to predict what's going to happen in regards of the impact of the Affordable Care Act on hospitals and consumers."
However, one local group that could benefit from the bill is the low income, uninsured residents of Montgomery County. The Affordable Care Act provides tax credits for individuals and families with income levels between 100 and 400 percent of the federal poverty level—$11,490 to $45,960 for individuals or $23,550 to $94,200 for a family of four.
Of the 23 percent of uninsured Texans—4.89 million—about 92 percent could be eligible for tax credits, according to the U.S. Department of Health and Services.
Randy Johnson, CEO of the Montgomery County Hospital District, said MCHD provides public health and emergency medical services to uninsured residents of Montgomery County, who can each receive up to $60,000 worth of coverage annually. Johnson said about 60,000 of the nearly 500,000 residents countywide are eligible for MCHD's services, provided to residents below 133 percent of the poverty line.
He said the Affordable Care Act could lead to a significant reduction in the number of residents eligible for MCHD's services over time as more uninsured residents obtain insurance. Johnson said residents at 100 percent or below of the federal poverty line could be covered for 100 percent of their health insurance costs. About 11.5 percent of Montgomery County residents were below the poverty line as of 2010.
"I think the service level [provided by MCHD] will be the same," he said. "But assuming nothing changes with the act, I think [MCHD's] tax rate [of 7.27 cents per $100 valuation] will stay flat or decrease over the next few years."
Health care industry
Local health care organizations are already implementing changes because of Affordable Care Act requirements, but with questions still remaining about the effects of the bill, some changes could still be on the horizon.
Sanders said he does not foresee issues with the level of care provided by Memorial Hermann in The Woodlands, although he questioned whether the hospital would continue providing certain services, including care to uninsured patients. He also does not know whether the hospital will see more patients since Texas opted not to expand its Medicaid coverage. Also, the number of uninsured who will find coverage through the exchange remains unknown.
"We believe because the individual mandate for not seeking health insurance is so minimal, that a lot of young people are not going to sign up for insurance," Sanders said. "This is where the Affordable Care Act could fall apart. If you don't get young people to sign up for exchanges, and the only people to sign up are the chronically sick people, then costs are going to go up significantly."
Dr. Winnie King of Priority Emergency Room, a freestanding emergency room with locations in Katy and The Woodlands, said she anticipates more patients and believes emergency rooms nationwide will see patient increases. King said the business would consider adding staff if necessary to meet the higher demand.
"We're not concerned about it," she said. "We actually look forward to it. If people need care, that's the business that we're in, and that's precisely what we want to do."
Joanne Ducharme, director for Montgomery County Community Development, said MCCD is constructing its second countywide clinic for underinsured and uninsured residents of Montgomery County. Both clinics are already seeing the effects of the Affordable Care Act through new clinic requirements, Ducharme said.
The bill has changed requirements for holistic medicine, and the clinics are required to have more counseling rooms, she said. The Affordable Care Act also requires the clinics to have call stations so that doctors can follow up on examinations.
The existing clinic in Splendora sees as many as 20,000 patient visits a year, Ducharme said. She said she anticipates similar numbers at the Magnolia clinic and believes patient visits will continue to rise.
Individuals
The Affordable Care Act will allow for several groups of people to receive coverage who would not have been covered before, said Judy Bradby, CEO and founder of consulting firm, ProHealth Strategies from Virginia.
The bill allows for young adults up to age 26 to remain on their parents' insurance, or about 357,000 young adults in Texas, according to the U.S. Department of Health & Human Services. Bradby said the bill also allows coverage for those with chronic pre-existing conditions.
"It used to be if you had a pre-existing condition, you couldn't get coverage or you would have an annual or lifetime limit," she said.
However, the bill also implements mandates to individuals that begin Jan. 1 and to businesses that begins Jan. 1, 2015, penalizing those who opt against health coverage. Texans who are uninsured can shop for insurance through the Health Insurance Marketplace, a health care exchange in which consumers fill out an application and can view all available plans in their area, beginning Oct. 1.
Mike Fortner, president of High Point Financial Group Benefits in The Woodlands, said Texas is one of 27 states letting the federal government run its exchange.
Fortner said plans provided by the health care exchange vary in coverage levels from 60 percent to 90 percent, and consumers will pay higher premiums for more coverage. Although he said healthy consumers would likely pay higher premiums, because of the Affordable Care Act, rate costs can only be based on geographic area, age, tobacco use and whether the insuree enrolls as an individual or a family.
"It doesn't matter what your health condition was," Fortner said. "It doesn't matter whether you were close to death, you're going to pay the same rate as everyone else in your ZIP code."
Whether it is individuals or employers shopping insurance, Fortner said, consumers should expect a reduction in the number of doctors and hospitals covered by their insurance plans.
"Pay attention to your network when you're shopping health insurance, and get used to your network being smaller than it was before," he said.
