THE BUZZ: Healthy Uncertainty

By on December 20, 2016

How the repeal of Obamacare would affect thousands of Teton County residents.

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JACKSON  HOLE, WY – Teton County residents added to the record number of Americans hurrying to register for health insurance this week through the Patient Protection and Affordable Care Act (commonly referred to as ACA or Obamacare), as its future becomes increasingly uncertain.

Julia Heemstra has been an ACA navigator since its advent. The number of sign-ups over the last week is “jaw-dropping,” said Heemstra, director of the Wellness Department at St. John’s Medical Center.

Heemstra says she received more calls from folks interested in enrolling for coverage that begins January 1 than in years past. “Consumers are scared, and rightfully so,” she said.

People’s fear seemingly stems from President-elect Donald Trump’s murky plan for the future of ACA. He has stated he supports certain aspects of Obamacare such as coverage for pre-existing conditions. But he has also vowed to repeal ACA.

However, looking at what ACA has accomplished since its inception reveals its effectiveness at covering uninsured Americans.

In his last press conference of the year,  President Obama noted that before he took office, 44 million people were uninsured. Since its launch, ACA has covered more than 20 million people. For the first time, an unprecedented 90 percent of Americans are insured. Data from the National Health Interview Survey confirms this statistic. Just 8.6 percent of Americans across all ages lacked health insurance during the first quarter of 2016, the survey reported.

Obama also noted that December 15, the original deadline to sign up for insurance through ACA slated to begin January 1, was a record-breaking day. More than 670,000 people enrolled for insurance, and more than one million people requested information from Healthcare.gov, ACA’s online “insurance marketplace” portal.

Historically, Teton County has had one of the highest rates of uninsured residents in Wyoming. However, as Heemstra reports, the county has enrolled the highest percentage of its population in ACA insurance plans in the state. In 2016 alone, Teton County enrolled 2,812 individuals—12 percent of residents. The year before, in 2015, 2,722 residents signed up for coverage.

The consequences of changing or repealing ACA could be profound here. Heemstra warned significant changes to ACA would impact the community, even those who are not signed up for Obamacare.

“The majority of Teton County residents are insured in group plans through employers, and the ACA established strict guidelines that really protect employees,” she explained. These guidelines ensure all plans offer people minimum essential benefits, such as maternity care, mental health services, prescription drugs, preventative care and emergency services.

Jacksonites like Ben Johnson are among those concerned about the future of ACA. Johnson’s coverage through ACA drastically altered the outcome of an injury he sustained in 2014 while climbing the Middle Teton.

After he pulled a rock down on his finger and severed a flexor tendon, Johnson’s surgery and physical therapy amounted to a full year’s salary—$20,000. Johnson is a contract-based college field course instructor who does not receive worker’s compensation, sick leave, disability or unemployment.

Prior to his ACA coverage, his “catastrophic” policy had a deductible of $7,500 and an out of pocket maximum of $15,000. However, he ended up paying only about $3,500 through his ACA coverage.

“It could have been way worse with lesser or no insurance,” he said. Johnson says he likely would have had to leave Jackson. “I would be in enormous debt today.”

Heemstra is not surprised by Johnson’s story. “As someone on the front lines, I’ve seen the life changing difference [the ACA] has made,” she said.

Benedict Yat Long, a master’s student at University of Austin with a pre-existing condition, says he has significantly benefited from Obamacare coverage. Earlier this year he underwent surgery to correct a dramatic underbite. Though the surgery has improved his quality of life, without coverage through ACA, he says the operation would not have been covered. Instead his bill would have amounted to more than $100,000 with x-rays, molds, consultations and anesthesiologist fees, CT scans, blood tests and surgeon fees, to name just some of the associated costs.

With his insurance, Yat Long paid $1,000.

Preventative care, which Heemstra says aims to protect the patient and healthcare as a system, is one of ACA’s cornerstones.

“When we catch diseases early on, they’re easier and less expensive to treat,” she said. Hospitals don’t have to pay out as much from their patient assistance funds, people can afford their medication, and they’re receiving help before issues progress. Over time, Heemstra said this makes the whole population healthier.

But ACA, she says, was not designed to meet the needs of the entire U.S. population. “It’s purpose is to help people afford insurance who wouldn’t be able to otherwise.”

Wendell Field, a 51-year-old Jackson artist, is one of those people. He didn’t have insurance for several years because it was simply cost prohibitive, potentially draining about a third of his income each month. Now, he receives coverage through ACA, which makes insurance affordable. Without it, he would be paying more than $600 a month. He pays $80 with the Obamacare subsidy.

But although ACA has made insurance accessible to Field, he acknowledges flaws in the system. He’s noticed $75 doctor bills just for getting an ACE bandage put on. 

“How much is [allocated] to insurance companies and hospitals for inflated charges?” he wondered. Field lamented that providers do not appear to be held accountable to patients, or in communication with them. “The conventional ways of doing business don’t exist in healthcare,” he said.

Field has received medical care in Thailand, China, India, and New Zealand. He says in comparison, the U.S. system is expensive and confusing. In Thailand, he visited several specialists for a partially torn eardrum, and paid a total of $30 for treatment and medication. In contrast, Field had outpatient surgery for a torn hydrocele in Jackson in 2000. He doesn’t remember ever having a conversation with the surgeon before or after the procedure.  He said the surgery was very expensive and caused complications leading to doctor visits that were not covered by insurance.

He also wants to see providers embrace the benefits of holistic care. “My dad had a mental illness and he just kept being prescribed pills because it’s lucrative for doctors and drug companies,” he said. “It just masked the symptoms.”

Field believes that alternative health approaches might have saved his father, whose health subsequently deteriorated. But those treatments—from bodywork to counseling—are often not covered under insurance plans. In the current system, individuals often struggle through pain and debt alone. “We don’t have collective or community immunity anymore,” Field said.

However, ACA has taken steps to support communities in identifying collective health needs. Heemstra pointed out that Obamacare mandated that hospitals identify and respond to local factors impacting public health. “One of the strengths of the ACA was in asking communities to utilize their collective resources to start to address the community’s health needs,” she said.

In order to comply with ACA mandates, St. John’s Wellness Department collaborated with Teton County Public Health on the most comprehensive community health needs assessment to date. Through working with more than 35 organizations for 16 months, they identified 10 of the most urgent public health needs in Jackson. The top five included access to health services, severe housing conditions, food insecurity, routine health screenings, and transportation.

Cutbacks to ACA have already impacted the Cowboy State.

When Wyoming, along with 22 other states, rejected federal funding for Medicaid, Heemstra says it hurt the most vulnerable members of the populace. Without expanded Medicaid, many of Wyoming’s lowest income residents still couldn’t qualify for services because they didn’t meet the narrow standards for disability/health conditions or the income parameters designated for Medicaid recipients by the state. If these same residents fall under the 100 percent federal poverty level, they’re not eligible for subsidies on the marketplace.

This means someone who makes $6,000 a year is paying the same premiums for an ACA insurance plan as a person who makes $50,000 a year. “This is a tragedy,” Heemstra said.

Though navigators like Heemstra speculate significant changes will not be made to ACA insurance plans for 2017, she encourages people to sign up for coverage before January 31, and to take advantage of as many services as possible right now.

“It is not the time to put off preventative care,” she urged.

The last day of open enrollment for 2017 health insurance through ACA is January 31. Visit healthcare.gov for more information. PJH


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