Expansion of health insurance coverage does not equal access, according to Froedtert Health president and chief executive officer Cathy Jacobson.
In Milwaukee County, close to 50,000 new childless adults now have access to coverage under Wisconsin’s brand of Medicaid expansion.
Not all of those people, however, understand how to access the health care system, she said, and they end up accessing it the way they have always known: the emergency room, resulting in vast increases of area emergency room utilizations.
“We’re looking at how do we change the nature of how we deal with coverage in this area now that we got what we always asked for, which is coverage expansion,” Jacobson said.
Jacobson was one of several experts who convened on Monday at the Medical College of Wisconsin to share their perspectives on the Affordable Care Act for an audience that included educators, insurance providers, lobbyists and others. The event was organized by WisBusiness.com in recognition of the fifth anniversary of the signing of the Affordable Care Act into law on March 23.
Besides Jacobson, the panelists were Medical College of Wisconsin president and CEO Dr. John Raymond Sr., WEA Trust president and CEO Mark Moody and UW-Milwaukee health care economist Owen Thompson.
Overall, the panelists agreed the ACA has accomplished what it set out to do: expand coverage.
“My view from 10,000 feet is that the exchanges are basically working in broad terms,” Thompson said. He said ideally three to five cycles are needed to achieve a more complete judgment, but currently the ACA has had several successes, including the rate of growth in premiums in its second year—3 percent to 6 percent nationally—that signify some degree of competition in the exchanges.
Furthermore, he said there is a reasonably high number of insurers offering plans, and there is a reasonable number of new entrants.
Moody added that the ACA’s most dire predictions did not come true. For instance, he asserted that health care costs did not skyrocket, insurance companies and providers did not go bankrupt, and employers did not drop health insurance.
Raymond believes the ACA led to the acceleration of such factors as accountability and price transparency. The latter, he said, challenge academic medical centers, such as the Medical College of Wisconsin, which are more expensive due to their roles in training the next generation of medical providers and generating the next pipes of knowledge and innovation.
“We want to make sure that we preserve this pipeline for innovation, education and regeneration of knowledge, but when a patient goes to the exchange and they see an academic medical center priced higher than a very competent community health system, they’re going to choose the other system,” he said. “Everyone recognizes the need to have a strong academic medical center in their community, but it’s going to be difficult to continue justify paying for that with higher rates.”
The ACA has also led to new players in the health care industry such as Walgreens and CVS that Raymond said are “cherry picking the easy business” and putting pressure on traditional providers. He advises patients with more complex issues to go straight to higher cost providers because the outcomes will ultimately be less costly than going to the fringe providers first.
Still, he and Jacobson welcome those new players into the market because they say competition makes everyone better.
Also discussed at Monday’s event was the U.S. Supreme Court case King v. Burwell, which challenges the ability of federally run exchanges to provide subsidies that help people purchase insurance coverage.
Wisconsin, where about 126,000 people obtain coverage through the exchange, is one of 27 states that have adopted a federally-run exchange as opposed to a state-run exchange.
“It will be very disruptive if the Supreme Court rules against the subsidies,” Moody said. “It’s going to be economically disruptive, it’s going to be disruptive on some eight million people, and it’s going to be politically disruptive in ways that nobody can actually predict. And it could actually undermine the stature of the Supreme Court if not politicize it even further. There’s nothing that isn’t going to be touched by that ruling.”
The Supreme Court is expected to make a decision in June.
Hilary Dickinson is a reporter at BizTimes Milwaukee.
