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Patients, providers report mixed success with Affordable Care Act

Island artist Pam Ingalls signed up for health insurance earlier this year with the help of a local volunteer, one of many who assisted hundreds of islanders with the enrollment process when the state’s health insurance exchange opened in October.

Now, Ingalls and countless others across the country —  patients and health care providers alike — are settling in to the new insurance landscape created by the Affordable Care Act (ACA). On Vashon, the picture appears mixed, with some reporting optimism and greater access to care and others saying more change is needed for the program to be truly effective.

Ingalls, known to many for her oil paintings that hang in The Hardware Store Restaurant, says her new insurance plan is a welcome change. It replaced a high-deductible plan that resulted in her paying all her health care bills in addition to her high monthly insurance premiums. Now, she said, her premiums are half of what they used to be and her plan covers medical care she needs, including physician visits, lab tests and prescriptions.

“I feel like I’m getting something for the money I’m spending, plus the security of insurance. I guess other people — who have had regular insurance — have felt this kind of security all along,” she said. “But it’s a new experience for me, and I’m very grateful.”

With more people now insured, clinics throughout the country have reported bracing for a wave of patients. On Vashon, it appears that while physicians are busy, representatives of the island’s largest clinics say they have not been overwhelmed by a flood of newly insured patients seeking care.

Vashon’s Franciscan Medical Clinic has seen a number of new patients, Scott Thompson, a Franciscan spokesman said last week, but the clinic is not tracking whether the patients are newly insured because of the Affordable Care Act.

So far, he added, the state’s health exchange has not posed problems for Franciscan providers, and he noted the Franciscans support the intent of health care reform.

“We know that people with health insurance coverage are more likely to seek out preventative medical care rather than wait until they have a medical crisis,” he said.

At Fulton Family Medicine, manager Kathy Henke said a flood of newly insured patients has not been possible because that clinic has been closed to new patients temporarily. The clinic had received several new patients from routes other than the insurance exchange, she said, and the providers there could not keep up with the demand. A new nurse practitioner is supposed to begin next month, she said, and she hopes the clinic will be able to re-open to new patients at that time.

Henke noted that the clinic has experienced some difficulty because it was not included in some of the insurance plans offered through the exchange. She said one insurance representative told her that the clinic was excluded because it is not affiliated with any hospitals.

According to some who have worked closely with the exchange, a cumbersome aspect of the expanded Medicaid system — now in Washington called Apple Health — is that people are assigned a provider and then have to go through a process to make a change if desired.

Henke said her clinic has had problems with this, as some people have come in believing they had been assigned to that clinic, but actually were not. In some cases, Henke said, people have found they had been assigned to a plan with no providers on the island. And while it is possible to make changes, this area has been a been a stumbling block.

“I don’t think the exchange is going well,” she said. “Maybe it will as time goes on.”

At Vashon Natural Medicine, however, Kelly Wright, a naturopathic physician, has praise for the program and noted that for the first time, naturopathic physicians can see patients with Medicaid health benefits. Vashon Natural Medicine received its credentials to do so in January, Wright said, a move that she said was important so her office could continue to provide services for patients newly assigned to Apple Health and to serve new patients as well. Many islanders — children in particular — who had private insurance now qualify for Apple Health because of its expanded income parameters.

Apple Health sometimes reimburses physicians at a lower rate than private insurance companies, Wright noted, so many clinics limit or do not take patients with those benefits. When all providers take some of those patients, she said, it helps to provide care across the economic levels in a community.

At her clinic, so far the transition to the new system has been almost seamless, she said, and she believes once initial problems are dealt with, such as individuals being assigned to the wrong plan or provider, many will be better off.

“Once it straightens itself out, people will have a lot more coverage and options and will be happy,” she said.

At the Vashon Pharmacy, however, co-owner Tom Langland recently told a more cautionary tale, explaining that many people with Apple Health benefits might find that their plans do not meet their needs well because of those low reimbursement rates.

Of the five plans that provide Apple Health benefits, Langland said that the pharmacy will drop two by the end of March if the companies do not renegotiate their rates. Right now, he said those two plans reimburse the pharmacy at such a low rate that the business loses money on the medications themselves — to say nothing of paying for the staff time and other overhead expenses required to fill the prescriptions.

He suggested that people with Apple Health bring their cards in and talk to a pharmacy staff member to determine if their plan is one of those that may be dropped. If it is, he said, patients may wish to write those companies and express the need for the Vashon Pharmacy to be compensated fairly. They may also wish to change plans before March 31, he said.

There are few independent pharmacies left, Langland noted, and their cost structures are higher than those of the big chains. Additionally, he said, the Vashon Pharmacy itself is heavily staffed — more so than some of the large chains. There are always two pharmacists on staff, who fill and review the prescriptions and field patient questions, he said.

“That is basically how we sleep at night, how we know we have not given one of our neighbors the wrong dose or the wrong medication,” he said. “We are not going to change that to fit lower insurance reimbursement rates.”

Dentist Marc Langland shares similar concerns about reimbursement fees. While all children enrolled in Apple Health now have dental coverage as part of their insurance, on the island, Langland is the only dentist who accepts Apple Health plans and only on a limited basis.

The fees cover just a fraction of the cost of care, he said, and even if reimbursement fees were doubled, they would still fall short of covering his costs. To make matters worse, he said, by contract, he cannot bill patients for any of the shortfall, even if a patient would like to pay. In one recent example, he said, he billed more than $300 and the Apple Health plan reimbursed him $60. Among the wide network of dentists he knows, he said, he is the only one to accept patients with Apple Health benefits.

“We just do it as a service to help the need here,” he said. “We’re seeing as may people as we can afford.”

The office has a waiting list for Apple Health clients, he said, and staff frequently refer people out to off-island clinics and will now refer families with children to the dental van, which can provide some free dental services.

At Vashon Youth & Family Services, a nonprofit agency, the ACA has brought welcome changes, according to Kathleen Johnson, the executive director.

Several newly insured people have come in for services since the start of the year, Johnson said, adding she believes they sought care now because it will be covered. What’s more, she said, a pool of clients the agency had been seeing for free now has insurance coverage, and the agency will be reimbursed for their care.

“It could not have come at a better time for us. Having this additional opportunity for support for work we are already doing is important,” she said. “We’re celebrating.”

The ACA also expanded mental health benefits, and now, Johnson said, many people will have to pay less out of pocket for needed services.

“We see that as a sign of improvement for people who need mental health care,” she said.

On Vashon, exact numbers for how many people signed up for insurance coverage through the exchange are not available, according to authorities with the state exchange. However, information from islanders most involved in the process provides some indication.

LeeAnn Brown, an insurance agent at The Brown Agency, said she has signed up 148 households through the exchange and believes up to one-quarter had previously been uninsured.

Hilary Emmer, who coordinated the community volunteer assistants, said they signed up more than 370 households. She estimates at least 75 percent of those were previously uninsured. She believes another 20 percent, like artist Ingalls, are paying less now than they were before.

For most people, the open enrollment period to obtain health insurance for 2014 extends to March 31, Emmer said. After that, unless a person has a significant event, such as losing a job that provided insurance, gets married or has a child, obtaining insurance for this year through the exchange will not be possible. Open enrollment for 2015 will open in the fall. People who are eligible for free insurance, however, may enroll to obtain coverage this year at any time.

Brown noted that the process of signing people up is going much more smoothly now than in the beginning of the rollout, though she knows that not everyone understands they only have one more month to enroll.

“I am finding people do not realize open the open enrollment period ends March 31. There is confusion about that,” she said. “They need to take action now.”

LeeAnn Brown will continue to help people enroll in and outside of the exchange. Call her for more information at 567-4600.

Volunteer assistance will continue to be available from 10 a.m. to 1 p.m. Wednesdays at the library through March 27. Call Hilary Emmer for more information at 463-7277.

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