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October 1st, Healthcare, and You?

Posted By Benjamin Miller, Monday, September 30, 2013

Health Insurance Exchanges will likely bring more patients to the doors of all providers


Depending on what radio talk show you listen to or what news talk shows you watch, tomorrow, October 1st, is either going to be a smashing success bringing help to millions or a cataclysmic failure bringing death and destruction. Yes, I am referring to the health insurance exchanges.

Before we dive into those weeds, let me back up just a few feet and discuss how we got here.

Health care is broken.

Healthcare is expensive.

Healthcare doesn’t give us the outcomeswe should get for what we pay.

Many people do not have any access to health insurance and medical care.

Some of you may recall a small piece of legislation that was passed into law called the Patient-Protection and Affordable Care Act. This law was intended to fix many of the problems highlighted above. There are quite a few moving pieces in PPACA, and it is important to understand the law as a whole before breaking it down into the specifics around implementation (and the impact that will have on mental health and primary care, which I will not do here). There are many substantial overviews that can be found online that explain PPACA in detail (e.g. Waits et al.). I encourage those of you who do not about the law to read through this document as there is everything you would want to know about "ACOs”, "PCMH”, and other fun and exciting acronyms.

A few more small details.

It is important to also remember that many of the provisions of PPACA are on the public side (CMS – Medicare and Medicaid). Take for example Medicaid expansion using the state I live in and CFHA will land in next week. In Colorado, there will be Medicaid expansion starting January 2014. Of course, other states have not gone the same route as Colorado leaving local and state politics to decide what will and will not happen with expansion.

Back to the exchanges.

Health insurance exchanges are going to have an impact on everyone
Health insurance exchanges are going to have an impact on all healthcare folks in all types of practices. In Colorado, for the approximately 800k uninsured, there is going to be an option for them to gain access to health insurance. Recently, the Colorado Division of Insurance announced the rates of the plans (including those on the exchange). You can find that info here(and it gives you a good idea as to which plan may be chosen by those who have not had insurance before). Also, you can find out more about the exchange in general here. The point is that there will be an influx of new patients looking for providers who can help them with their problems.

Ironically, patients most likely to benefit from the exchanges starting tomorrow are those often least aware.

So, the exchanges will likely bring more patients to the doors of all providers (and remember, mental health parity was in the ACA, too).

What will happen tomorrow? Well, it is expected that "most federally run exchanges will offer more plans, lower premiums than expectedone HHS report shows. Those states that are setting up exchanges on their own (e.g. Colorado), we will have to see their impact starting tomorrow.

Bottom line: Having more people covered (with choices) is likely to help get people the care they need. Do health exchanges fix healthcare? No, but they do solve a problem that is so pervasive in our country – they help connect those with no insurance to a plan they can afford that will cover them.

Some progress is better than no progress.


Dr. Miller is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. He leads the Agency for Healthcare Research and Quality’s Academy for Integrating Behavioral and Primary Care project as well as the Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) project in Colorado and Oregon. He is the co-creator of the National Research Network’s Collaborative Care Research Network and is the past President of the Collaborative Family Healthcare Association. He is the section editor for Health and Policy for Families, Systems and Health and reviews for several academic journals. Dr. Miller is a technical expert panelist on the Agency for Healthcare Research and Quality Innovations Exchange and on the International Advisory Board of the British Journal of General Practice. Dr. Miller’s research interests include models of integrating mental health and primary care, health behavior interventions, primary care practice redesign, using practice-based research networks to advance whole person healthcare, and healthcare policy.

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Matthew P. Martin says...
Posted Monday, September 30, 2013
There is a fine line between excitement and fear and that certainly applies to October 1, 2013. I am very curious to see how these exchanges work out, especially for states like my own (NC) that are not expanding Medicaid or managing the exchanges. As you conclude, there are a lot of people who need coverage and these exchanges are a step in that direction.
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