Blog : Promising Much, Obamacare Does Not Always Deliver As Advertised

By Herb | Feb 20, 2014 | in

BY HEIKKI (HERB) PERRY
Green Alliance Staff Writer

Well-known are the start-up problems with Obamacare — aka the Affordable Care Act. However, government officials are telling us that once the initial bugs in the system were solved, people seeking affordable comprehensive health-care coverage would be able to find it.

But is that really the case in New Hampshire and Maine? For a naturopathic doctor in New Hampshire that has not been true. And for a Maine chiropractor, it’s too early to tell.

People who do not have health insurance, are looking to change insurance policies or do not have access to coverage through their employer can sign up for health insurance during open enrollment until March 31. Federally funded subsidies to help people pay for the cost of their insurance are also still available, according to a joint press release by Covering New Hampshire, U.S. Rep. Carol Shea-Porter’s office, the N.H. Dept. of Insurance, and Anthem Insurance.

“For many, their new health insurance plans include the comprehensive health care they were looking for at a lower price than they had previously paid,” the statement said, adding, “Thousands of people have also contacted Covering New Hampshire, the state’s official source for information and assistance on the Health Insurance Marketplace, looking for information about obtaining health coverage in the new year. These people are learning that regular doctor visits, medications, important preventative health screenings and other treatments are now more reasonably priced through the Health Insurance Marketplace.

Under the Affordable Care Act, 51 percent of currently uninsured nonelderly people in New Hampshire are eligible for financial assistance in gaining coverage. About 62,000 (more than one in three) uninsured people from New Hampshire are eligible for tax credits to help them purchase coverage in the Marketplace.

Federal subsidies are available to individuals making up to $45,960 a year and up to $126,360 for a family of six. According to the Kaiser Family Foundation subsidy calculator, available on the Covering New Hampshire Web site:

• A single person in his or her 40s, making $36,000 per year, will pay $285 per month for health-care coverage in 2014.
• A middle-aged couple making $45,000 will pay $345 monthly.
• A single parent in his or her 30s with two children, and making $40,000, will pay $215 per month.
• A family with two parents and two children, making $56,000 per year will pay $355 per month.
• A two-parent family with three children, making $90,000 per year, will pay $750 monthly.

Each of these families’ income level qualified them for a subsidy. The family of five (the last example above) received a $6,000 subsidy, cutting their annual payment nearly in half, and the single person (the first example) received a $9,800 subsidy, paying for nearly three-quarters of the annual premium cost.

What’s the reality on the ground?

“As a provider, it’s very disheartening to see the Affordable Care Act unfold,” said Dr. Robyn Giard, a naturopathic doctor at Starry Brook Natural Medicine in Exeter, N.H. “Many patients we process now often have bigger deductibles than with the health-care coverage they had before. Some of the reforms were really necessary, but I don’t think we’ve seen the bonus side of the act just yet. It’s been a learning process for both patients and providers.”

The silver lining, Dr. Giard says, is that patients with ACA coverage are now educating themselves more about their own health-insurance plans. They’re asking better questions; becoming more informed about their health care; and looking at their hospital bills and asking questions about them, especially expensive tests and whether they are necessary.

“While I am seeing more patients because of ACA insurance coverage, I’m still not able to help enough people because the month-to-month out of pocket expenses for those on ACA is so great,” Giard said. “For example, I have a patient paying out of pocket $150 a month for insurance and the patient’s co-pay for a sick visit was $98. The patient had to choose between going back to the doctor, since the patient’s problem had not resolved, and going grocery shopping. Even with the ACA, patients’ budgets still take a hit, which makes good health care prohibitively expensive.”

That’s why another law, passed in New Hampshire in 2013, is helping Dr. Giard’s patients more than the Affordable Care Act, she said. It requires insurers to provide coverage for services delivered by naturopathic doctors if those services would be covered when provided by other primary care providers. “I think it’s working very well. It took a long time for people to understand it, but now I think it’s working very smoothly,” she said.

Under that law, Starry Brook accepts insurance plans from Aetna, Blue Cross Blue Shield, Cigna, Harvard Pilgrim, Tufts, and United Healthcare. Because of the law, 90 percent of Starry Brook patients have insurance. “It’s completely different than it used to be,” said Giard.

And that has put patients who qualify for the coverage in a better state of mind.

“Instead of paying an almost $200 bill, I had to pay a $20 co-pay in my last visit. It’s amazing. It’s a huge change,” said Laura E. Mayer, a Starry Brook patient covered by Tufts Health Plan.

In the past Mayer had to pay 100 percent of the bill, a situation that forced her to choose among necessary medical tests and procedures, postponing some to a later date. “I couldn’t get them all done because I didn’t have the money. Insurance and finances do direct care,” Mayer said.

Seventy-five percent of patients who visit Great Works Chiropractic & Wellness in South Berwick, Maine, have some type of insurance plan. “We’ve had a couple of patients covered under the Affordable Care Act so far. But they had high-deductible plans, so we didn’t get to see how the plan covers our procedures or for how much. But the deductibles seemed to be in the thousands of dollars,” said Dr. Seth LaFlamme, adding, “With only two of them presenting to us so far, we haven’t gotten enough polices for a good sample.”

Dr. LaFlamme notes that the nature of chiropractic care doesn’t always jibe with the realities of the way health insurance is structured. Chiropractic helps people achieve their overall wellness; it is not disease-only focused. But no insurance policy pays patients to be healthy, he said, likening wellness promotion to the benefits patients derive from a gym membership. “There is a big gap between not being sick, being OK, and being truly well,” he said.

So, Great Works’ patients often receive treatment that insurance companies don’t cover, “a weird in-between territory that we occupy,” said Dr. LaFlamme. Great Works does adhere to its contracts with insurance companies, but it also serves patients the best way it can. The trouble is that insurance plans are not designed by people who understand chiropractic. Some plans cover 40 visits; others cover six. “We do our best, but given the parameters under which we work, that doesn’t always mean that we’re getting to the heart of the underlying cause of sickness,” Dr. LaFlamme said.

Health insurance is focused on sickness and disease. “The day before your heart attack, were you healthy?” Dr. LaFlamme asked rhetorically. “In fact, disease presenting itself today in a patient may have been developing for years before that. Treatment of disease has been moving away from health for a long time. We’ve just shaved the tip off the iceberg. There’s a lot more we can do to help people. And that situation hasn’t changed that at all with the ACA. It’s not bad; it’s not good; it’s just the way it is.”

Both Starry Brook Natural Medicine and Great Works Chiropractic & Health are Business Partners of the Green Alliance, a union of local sustainable businesses promoting environmentally sound business practices, and a green co-op offering discounted green products and services to its members.

For more information about Starry Brook Natural Medicine, visit www.starrybrook.com.

For more information about Great Works Chiropractic & Health, visit http://greatworkschiro.com/

For more information about the Green Alliance, visit www.greenalliance.biz.

Under the Affordable Care Act, all uninsured people must be enrolled by March 31, 2014, to avoid penalties.

Resources for ACA insurance exchange marketplace include:
• Federal: U.S. Department of Health and Human Services, www.healthcare.gov and the 24-hour Help Center at (800) 318-2596
• Small Business Administration: www.sba.gov/healthcare, http://business.usa.gov/healthcare and the SBA Hotline at (800) 706-7893 from Monday to Friday, 9 a.m. to 5 p.m.
• New Hampshire: State Insurance Department, www.nh.gov/insurance and the consumer hotline at (800) 852-3416; Department of Health and Human Services at www.healthcare.nh.gov; and the H.H. Health Plan atwww.nhhp.org/nhhp/
• Maine: State Bureau of Insurance at www.maine.gov/pfr/insurance
• Covering New Hampshire (coveringnewhampshire.org)