News / USA

Doctors, Hospitals Expect Some Confusion as Obamacare Plans Start

FILE - Doctors confer in the neonatal intensive care unit of the Holtz Children's Hospital at Jackson Memorial Hospital in Miami, Florida.
FILE - Doctors confer in the neonatal intensive care unit of the Holtz Children's Hospital at Jackson Memorial Hospital in Miami, Florida.
Reuters
Hospitals and medical practices across the United States braced for confusion and administrative hassles as new insurance plans under President Barack Obama's healthcare law took effect on Wednesday.
 
More than 2 million people enrolled in private plans offered under the Affordable Care Act, popularly known as Obamacare, during the initial sign-up period for health benefits. Enrollment began in October and lasts through March, but Americans in most states had to enroll by last week to get coverage that takes effect with the start of the new year.
 
The expansion of coverage through the new plans is one of the main parts of the 2010 law, the most sweeping U.S. social legislation in 50 years. Over time, the law - which requires most Americans to buy insurance, offers subsidies to help low-income people get covered and sets minimum standards for coverage - aims to dramatically reduce the number of Americans who lack health insurance, which the U.S. government has estimated at more than 45 million.
 
After a difficult October launch plagued by problems with the website used to enroll people in coverage, the focus for the government and healthcare providers has turned to what will happen beginning on Wednesday when patients with the new coverage start to seek care.
 
The law still faces political and legal hurdles. Roman Catholic Church-affiliated organizations obtained last-minute court injunctions on Tuesday that gave them temporary exemptions from a part of the healthcare law that requires employers to provide insurance policies covering contraception.
 
U.S. Supreme Court Justice Sonia Sotomayor granted one temporary injunction to Baltimore-based Little Sisters of the Poor and Illinois-based Christian Brothers Services, plus related entities.
 
The Centers for Medicare and Medicaid Services, or CMS, part of the U.S. Department of Health and Human Services, had 10,000 agents on call for New Year's Eve and New Year's Day to field questions from people dealing with enrollment problems.
 
“We are ready ourselves to assist consumers as well with our full complement of call center representatives available,” said Julie Bataille, spokeswoman for the CMS.
 
At the start, confirming a patient's plan may present headaches for care providers. The Obama administration has acknowledged that errors occurred in transmitting enrollment data to insurers, especially early in the enrollment period.
 
“It will be difficult for us to actually verify coverage - that's my concern,” said Dr. William Wulf, chief executive of Central Ohio Primary Care, which has 250 primary-care physicians.
 
The task could be made more difficult by decisions by the U.S. government and many states to push back enrollment deadlines toward the end of the year. The late deadlines mean that many enrollees who seek care initially may lack insurance cards or other proof of coverage.
 
Wulf said his physician offices will assume existing  patients are covered if they say they are when they come in for appointments and their coverage cannot be verified immediately. But if they require expensive tests, such as MRIs or heart-stress tests that can cost up to $700, the practice will check with insurers first to make sure the patient has coverage.
 
Dr. Andy Chiou, chief executive of Peoria Surgical Group Ltd in Illinois, said that if the practice finds a “significant minority” of its patients do not have coverage when they believe they do, it might delay elective surgeries for patients until their insurance is confirmed.
 
“For the protection of patients and us, we'll have to say,  'Sorry, you don't have insurance,”' Chiou said.

Political Stakes High
 
For the Obama administration, the political stakes are high in ensuring a smooth transition period for coverage, particularly after the website's problems damaged the popularity of the Democratic president and the healthcare overhaul, his signature domestic achievement.
 
Republicans, who have called Obamacare a costly program that will rob many Americans of insurance choices, have said they will make Obamacare's problems their top issue in the November 2014 elections, when control of Congress will be at stake.
 
The U.S. government has tried to anticipate the coverage problems new enrollees might encounter. The federally run  Healthcare.Gov website posted advice last week on what enrollees should do if they have not received an insurance card, encounter problems getting coverage for a drug prescription, or need to appeal a decision by an insurer.
 
“For consumers whose marketplace coverage begins on January 1, we're doing everything we can to help ensure a smooth transition period,” Kathleen Sebelius, the U.S. secretary of health and human services, said in blog posting on Tuesday.
 
“What we are stressing to folks is that if they get to a provider (and) there is some confusion (about coverage), call their insurer,” White House health policy adviser Phil Schiliro said. “If the insurer is not able to resolve it, they should call our toll-free number (800-318-2596) ... and operators will be there 24/7.”
 
Some healthcare companies are trying to get ahead of potential problems as well.
 
The pharmacy chain Walgreen Co said on Monday it would allow consumers who had not yet received plan identification numbers from their insurers to get prescriptions at no upfront cost in January, if they could provide evidence of their coverage or pharmacy staff could otherwise confirm it.
 
Wal-Mart said on Tuesday it would institute a similar practice.

Hospitals ready for change
 
Hospital executives said they were ready for potential hiccups with the newly insured.
 
The vast majority of Americans have employer-based coverage and Medicare plans and can choose new plans every January, so executives said the beginning of the Obamacare plans represented a more intense version of an insurance transition period they were already familiar with.
 
“Hospitals feel like they're pretty well prepared because they've had systems in place and tools in place to work through these sorts of issues,” said Jeff Goldman, vice president of coverage policy for the American Hospital Association. “We expect an uptick in volume, but we don't think it's anything beyond what most hospitals are prepared to handle.”
 
As many as 7 million people were expected to sign up for coverage in the Obamacare plans for 2014, but enrollment is so far well short of that figure, largely because of the problems with the HealthCare.gov website. Residents of 36 states use the site to enroll. Those in the other 14 states use state-run websites. Hospitals, therefore, may have been preparing for more new enrollees than they are likely to see at this point.
 
At New York's Montefiore Medical Center, staffers were trained on how the new healthcare plans work, partly so they could help patients resolve any coverage issues, said Lynn Richmond, the medical center's chief of staff.
 
“There's not a lot of active worry on our part,” Richmond said. “We feel ready to manage the hiccups.”
 
Indeed, many have eagerly anticipated the law's broadening of coverage. Across the country, hospital operators' finances have been weighed down by patients who have been unable to pay their bills because they lacked sufficient insurance.
 
“We're looking forward to the first quarter and beyond because we feel we're in a very good position to benefit from the ACA,” said Steven Campanini, a spokesman for Tenet Healthcare Corp, one of the largest publicly traded hospital chains.

You May Like

Video Migrants Caught in No-Man's Land In French Port

The deaths of hundreds of migrants in the Mediterranean this week has only recast the spotlight on the perils of reaching 'Fortress Europe' More

Video Westgate Mall Attack Survivors Confront Painful Memories

On anniversary of terror attack, survivors discuss how they have coped with trauma they experienced that day More

New Hints That Dark Matter Exists

New evidence from International Space Station hints at existence of dark matter and dark energy More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Migrants Caught in No-Man's Land Called Calaisi
X
Lisa Bryant
September 19, 2014 5:04 PM
The deaths of hundreds of migrants in the Mediterranean this week has only recast the spotlight on the perils of reaching Europe. And for those forunate enough to reach a place like Calais, France, only find that their problems aren't over. Lisa Bryant has the story.
Video

Video Migrants Caught in No-Man's Land Called Calais

The deaths of hundreds of migrants in the Mediterranean this week has only recast the spotlight on the perils of reaching Europe. And for those forunate enough to reach a place like Calais, France, only find that their problems aren't over. Lisa Bryant has the story.
Video

Video Westgate Siege Anniversary Brings Back Painful Memories

One year after it happened, the survivors of the terror attack on Nairobi's Westgate Shopping Mall still cannot shake the images of that tragic incident. For VOA, Mohammed Yusuf tells the story of victims still waiting for the answer to the question 'how could this happen?'
Video

Video Militant Assault in Syria Displaces Thousands of Kurds

A major assault by Islamic State militants on Kurds in Syria has sent a wave of new refugees to the Turkish border, where they were stopped by Turkish border security. Turkey is already hosting about 700,000 Syrian refugees who fled the civil war between the government and the opposition. But the government in Ankara has a history of strained relations with Turkey's Kurdish minority. Zlatica Hoke reports Turkey is asking for international help.
Video

Video CERN Accelerator Back in Business

The long upgrade of the Large Hadron Collider is over. The scientific instrument responsible for the discovery of the Higgs boson -- the so-called "God particle" -- is being brought up to speed in time for this month's 60th anniversary of the European Organization for Nuclear Research, known by its French acronym CERN. Physicists hope the accelerator will help them uncover more secrets about the origins of the universe. VOA’s George Putic reports.
Video

Video Whaling Summit Votes to Uphold Ban on Japan Whale Hunt

The International Whaling Commission, meeting in Slovenia, has voted to uphold a court ruling banning Japan from hunting whales in the Antarctic Ocean. Conservationists hailed the ruling as a victory, but Tokyo says it will submit revised plans for a whale hunt in 2015. Henry Ridgwell reports from London.
Video

Video Russian Economy Reeling After New Western Sanctions

A new wave of Western sanctions is hitting Russia’s economy hard. State-owned energy firms continue to bleed profits and Russia’s national currency plunged to a new low this week after the U.S. and the European Union announced new sanctions to punish Russia's aggressive stance in eastern Ukraine. But as Mil Arcega reports, the sanctions could also prove costly for European and American companies.
Video

Video Belgian Researchers Discover Way to Block Cancer Metastasis

Cancer remains one of the deadliest diseases, despite many new methods to combat it. Modern medicine has treatments to prevent the growth of primary tumor cells. But most cancer deaths are caused by metastasis, the stage when primary tumor cells change and move to other parts of the body. A team of Belgian scientists says it has found a way to prevent that process. Zlatica Hoke has more.
Video

Video Mogadishu's Flood of Foreign Workers Leaves Somalis Out of Work

Unemployment and conflict has forced many young Somalians out of the country in search of a better life. But a newfound stability in the once-lawless nation has created hope — and jobs — which, some say, are too often being filled by foreigners. Abdulaziz Billow reports from Mogadishu.
Video

Video A Dinosaur Fit for Land and Water

Residents and tourists in Washington D.C. can now examine a life-size replica of an unusual dinosaur that lived almost a hundred million years ago in northern Africa. Scientists say studying the behemoth named Spinosaurus helps them better understand how some prehistoric animals adapted to life on land and in water. The Spinosaurus replica is on display at the National Geographic museum. VOA’s George Putic has more.
Video

Video Iraqi Kurdistan Church Helps Christian Children Cope find shelter in churches in the Kurdish capital, Irbil

In the past six weeks, tens of thousands of Iraqi Christians have been forced to flee their homes by Islamic State militants and find shelter in churches in the Kurdish capital, Irbil. Despite U.S. airstrikes in the region, the prospect of people returning home is still very low and concerns are starting to grow over the impact this is having on the displaced youth. Sebastian Meyer reports from Irbil on how one church is coping.
Video

Video NASA Picks Boeing, SpaceX to Carry Astronauts Into Space

The U.S. space agency, NASA, has chosen Boeing and SpaceX companies to build the next generation of spacecraft that will carry U.S. astronauts to the International Space Station by the year 2017. The deal with private industry enables NASA to end its dependence on Russia to send space crews into low Earth orbit and back. Zlatica Hoke has more.
Video

Video Future of Ukrainian Former President's Estate Uncertain

More than six months after Ukraine's former President Viktor Yanukovych fled revolution to Russia, authorities have yet to gain control of his palatial estate. Protesters occupy the grounds and opened it to tourists but they are also refusing to turn it over to the state. VOA's Daniel Schearf reports from Mezhigirya, just north of Kyiv.


Carnage and mayhem are part of daily life in northern Nigeria, the result of a terror campaign by the Islamist group Boko Haram. Fears are growing that Nigeria’s government may not know how to counter it, and may be making things worse. More

AppleAndroid