By Lewis Krauskopf and Julie Steenhuysen
Jan 1 Hospitals and medical practices across the
United States are bracing for confusion and administrative
hassles as new insurance plans under President Barack Obama's
healthcare law take effect on Wednesday.
More than 2 million people enrolled in private plans offered
under the Affordable Care Act, popularly known as Obamacare,
during the initial sign-up period for health benefits starting
Jan. 1. Enrollment began in October and lasts through March, but
Americans in most states had to enroll by last week to get
coverage that takes effect with the start of the new year.
The expansion of coverage through the new plans is one of
the signature parts of the 2010 law, which is the most sweeping
U.S. social legislation in 50 years. Over time, the law - which
requires most Americans to buy insurance, offers subsidies to
help low-income people get covered and sets minimum standards
for coverage - aims to dramatically reduce the number of
Americans who lack health insurance, which the U.S. government
has estimated at more than 45 million.
After a difficult October launch plagued by problems with
the website used to enroll people in coverage, the focus now for
the government and healthcare providers has turned to what will
happen beginning Wednesday, when patients with the new coverage
start to seek care.
At the start, confirming a patient's plan may present
headaches for care providers. The Obama administration has
acknowledged that errors occurred in transmitting enrollment
data to insurers, especially early in the enrollment period.
Although government officials say they have dramatically
improved the process, healthcare providers are concerned about
problems or delays in verifying coverage with insurers.
"It will be difficult for us to actually verify coverage -
that's my concern," said Dr. William Wulf, CEO of Central Ohio
Primary Care, which has 250 primary care physicians.
The task could be made more difficult by decisions by the
U.S. government and many states to push back enrollment
deadlines toward the end of the year, and to allow some patients
well into January to pay for coverage that is retroactive to the
start of the year.
The late deadlines mean that many enrollees who seek care
initially may lack insurance cards or other proof of coverage.
Wulf said his physician offices will assume that an existing
patient is covered if they claim to be when they come in for
appointments and their coverage cannot be verified immediately.
But if they require expensive tests, such as MRIs or
heart-stress tests that can cost up to $700, the Ohio practice
will check with insurers first to make sure the patient has
Similarly, Dr. Andy Chiou, CEO of Peoria Surgical Group Ltd
in Illinois, said that if the practice finds a "significant
minority" of its patients do not have coverage when they believe
they do, it might delay elective surgeries for patients until
their insurance is confirmed.
"For the protection of patients and us, we'll have to say,
'Sorry, you don't have insurance,'" Chiou said.
POLITICAL STAKES HIGH
For the Obama administration, the political stakes are high
in ensuring a smooth transition period for coverage,
particularly after the website's problems damaged the popularity
of the Democratic president and the healthcare overhaul, his top
Republicans who have called Obamacare a costly program that
will rob many Americans of insurance choices have said they will
make Obamacare's problems their top issue in the November 2014
elections, when control of Congress will be at stake.
White House health policy adviser Phil Schiliro said on
Tuesday that because of the intense focus on Obamacare,
"problems that have never gotten attention before will get some
The U.S. government has tried to anticipate the coverage
problems new enrollees might encounter. The federally run
Healthcare.Gov website last week posted advice on what enrollees
should do if they have not received an insurance card, encounter
problems getting coverage for a drug prescription, or need to
appeal a decision by an insurer.
"For consumers whose marketplace coverage begins on January
1, we're doing everything we can to help ensure a smooth
transition period," Kathleen Sebelius, the U.S. secretary of
health and human services, said in blog posting on Tuesday.
"What we are stressing to folks is that if they get to a
provider (and) there is some confusion (about coverage), call
their insurer," Schiliro said. "If the insurer is not able to
resolve it, they should call our toll-free number (800-318-2596)
... and operators will be there 24/7."
Some healthcare companies are trying to get ahead of
potential problems as well.
The pharmacy chain Walgreen Co said on Monday that
it would allow consumers who have not yet received a plan
identification number from their insurer to get prescriptions at
no upfront cost in January, if they can provide evidence of
their coverage or pharmacy staff can otherwise confirm it.
Wal-Mart on Tuesday said it would institute a similar
HOSPITALS READY FOR CHANGE
Hospital executives, meanwhile, said they were ready for
potential hiccups with the newly insured.
The vast majority of Americans have employer-based coverage
and Medicare plans and can choose new plans every January, so
executives said the beginning of the Obamacare plans represented
a more intense version of an insurance transition period they
already are familiar with.
"Hospitals feel like they're pretty well prepared because
they've had systems in place and tools in place to work through
these sorts of issues," said Jeff Goldman, vice president of
coverage policy for the American Hospital Association. "We
expect an uptick in volume, but we don't think it's anything
beyond what most hospitals are prepared to handle."
As many as 7 million people were expected to sign up for
coverage in the Obamacare plans for 2014, but enrollment so far
is well short of that figure largely because of the problems
with the HealthCare.gov website. Residents of 36 states use the
site to enroll; those in the other 14 states use state-run
websites. Hospitals, therefore, may have been preparing for more
new enrollees than they are likely to see at this point.
At New York's Montefiore Medical Center, staffers were
trained on how the new healthcare plans work in part so they can
help patients resolve any coverage issues, said Lynn Richmond,
the medical center's chief of staff.
"There's not a lot of active worry on our part," Richmond
said. "We feel ready to manage the hiccups."
Indeed, many have eagerly anticipated the law's broadening
of coverage. Across the nation, hospital operators' finances
have been weighed down by patients who have been unable to pay
their bills because they lacked sufficient insurance.
"We're looking forward to the first quarter and beyond
because we feel we're in a very good position to benefit from
the ACA," said Steven Campanini, a spokesman for Tenet
Healthcare Corp, one of the largest publicly traded