ENID, Okla. —
In this, the third year under the Affordable Care Act, commonly called Obamacare, the brave new world of health care is becoming clearer, at least somewhat.
“I think there’s still some questions,” said Stan Tatum, chief executive officer at St. Mary’s Regional Medical Center. “Certainly we have more answers as to its enforceability and constitutionality.”
“Some of the uncertainty has been removed,” said Jeff Tarrant, president of Integris Bass Baptist Health Center. “Is the act going to be repealed? No, that clearly is not going to happen.
“There’s still some unknown. Some parts of this you don’t know how they’re going to work until you implement them.”
The cost of not having health insurance
One aspect of ACA is the expansion of Medicaid coverage, a provision states are allowed to opt out of after a Supreme Court ruling. Oklahoma has opted to opt out.
“That’s of significant concern to Oklahoma health care providers,” said Tarrant. “It’s of significant concern to a portion of our population, who, if Medicaid expansion were allowed to be implemented, would have health insurance.”
Oklahoma Gov. Mary Fallin rejected expanding Medicaid coverage that her administration said would cost the state some $475 million between now and 2020. The Oklahoma Policy Institute, however, says that figure is much lower, with the expansion potentially costing the state $28 million to $37 million per year in 2020.
The Affordable Care Act originally mandated states would expand Medicaid to cover people younger than 65 with income below 133 percent of the federal policy level. But last June the U.S. Supreme Court struck that down, giving states a choice in the matter.
Beginning in 2014, people whose employers do not offer health insurance will have the opportunity to purchase it directly in the Health Insurance Marketplace.
The largest remaining question concerning the Affordable Care Act, Tatum said, is how many uninsured people will take advantage of the opportunity the law offers to have some form of health insurance.
“There’s a big part of me that really questions if they will,” said Tatum.
Those who can afford it and who elect not to have health insurance will be subject to a fine beginning in 2014 under the so-called individual mandate.
“The penalty itself may be quite a bit less than the cost of paying the insurance premium,” Tatum said.
And even if people take advantage of the government-sponsored insurance, the question becomes how many medical providers will refuse to accept it, as some decline to accept Medicare and Medicaid patients now, Tatum said.
“There’s a real question mark about will this really translate into access for these individuals or will they continue to use hospital emergency rooms because they can’t get a primary care physician?” Tatum said. “And Oklahoma’s been ranked the No. 1 state in the U.S. for a shortage of primary care physicians. If they don’t, it’s been a one-sided deal, and we end up losing a lot in the process.”
Tatum said hospitals could benefit if people who currently are uninsured “do sign up for some kind of health insurance.”
At present, Tatum said, if an uninsured person is treated at the St. Mary’s emergency room, “we are lucky to collect two cents on the dollar.” Uninsured patients represent about 7 percent of St. Mary’s business.