While some governors are apprehensive about expanding Medicaid, as part of the Affordable Care Act, some are also not considering setting up health insurance exchanges.
Each state is charged with setting up a network of insurers for individuals and small businesses. It would give the working poor — those who don’t qualify for Medicaid or are not offered insurance through their employer — an opportunity to have coverage. Beginning in 2017, the exchanges will be opened to large businesses.
Individuals earning between 133 and 400 percent of the national poverty level would qualify for subsidies offered through the exchanges. The amount of the subsidy depends on individuals’ incomes, as determined by a sliding scale.
The health insurance exchanges are being compared to the concept of a travel website like Expedia or Travelocity. Citizens go to a site for information on health insurance plans, compare rates and see if they qualify for tax breaks.
There is uncertainty on what doctors’ payment rates will be from these plans, as those details are yet to be established.
“None of us have enough clarity as to what the exchanges are going to be about,” said Kirk Calhoun, president of The University of Texas Health Science Center at Tyler. “That lack of clarity is certainly concerning to those of us who are involved in health care.”
“The idea of a ‘state’ exchange is nothing more than an illusion,” said Josh Havens, Perry’s deputy press secretary said in a statement.
“The state would have to set up an exchange as dictated and approved by the federal government or the federal government would set it up themselves. Either way, any exchange would be the fed’s exchange.”
Tyler’s three major hospitals’ uncompensated care totaled more than $285 million in 2011. With the ACA moving forward, the cushion that hospitals have to help care for the low-income patients may be in jeopardy. The Disproportionate Share Hospital (DSH) program provides all hospitals funding for poor and uninsured patients.
Under the health care law, DSH payments will be phased out but the hospital industry is being promised that the expansion of coverage through health insurance exchanges and Medicaid would replace that.
“If those programs that provide federal funds that help care for the uninsured go away, but there’s no coverage expansion because the exchanges don’t work or there’s no Medicaid expansion then it will leave providers, physicians and hospitals in a precarious position,” Calhoun said.