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

    Top US General: Turkish Media Report ‘Absurd'

    General Dunford rejects ‘irresponsible' claims of coup involvement by former four-star Army General Campbell, who led NATO forces in Afghanistan before retiring earlier this year

    Video Saving Ethiopian Children Thought to Be Cursed

    'Omo Child' looks at efforts of one African man to stop killings of ‘mingi’ children

    Protests Over Western Troops Threaten Libyan 'Unity' Government

    Fears mount that Islamist foes of ‘unity' government plan to declare a revolutionaries' council in Tripoli

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    London’s Financial Crown at Risk as Rivals Eye Brexit Opportunitiesi
    X
    VOA News
    July 25, 2016 5:09 PM
    By most measures, London rivals New York as the only true global financial center. But Britain’s vote to leave the European Union – so-called ‘Brexit’ – means the city could lose its right to sell services tariff-free across the bloc, risking its position as Europe’s financial headquarters. Already some banks have said they may shift operations to the mainland. Henry Ridgwell reports from London.
    Video

    Video London’s Financial Crown at Risk as Rivals Eye Brexit Opportunities

    By most measures, London rivals New York as the only true global financial center. But Britain’s vote to leave the European Union – so-called ‘Brexit’ – means the city could lose its right to sell services tariff-free across the bloc, risking its position as Europe’s financial headquarters. Already some banks have said they may shift operations to the mainland. Henry Ridgwell reports from London.
    Video

    Video Recycling Lifeline for Lebanon’s Last Glassblowers

    In a small Lebanese coastal town, one family is preserving a craft that stretches back millennia. The art of glass blowing was developed by Phoenicians in the region, and the Khalifehs say they are the only ones keeping the skill alive in Lebanon. But despite teaming up with an eco-entrepreneur and receiving an unexpected boost from the country’s recent trash crisis the future remains uncertain. John Owens reports from Sarafand.
    Video

    Video Migrants Continue to Risk Lives Crossing US Border from Mexico

    In his speech Thursday before the Republican National Convention, the party’s presidential candidate, Donald Trump, reiterated his proposal to build a wall along the U.S.-Mexico border if elected. Polls show a large percentage of Americans support better control of the nation's southwestern border, but as VOA’s Greg Flakus reports from the border town of Nogales in the Mexican state of Sonora, the situation faced by people trying to cross the border is already daunting.
    Video

    Video In State of Emergency, Turkey’s Erdogan Focuses on Spiritual Movement

    The state of emergency that Turkish President Recep Tayyip Erdogan has declared is giving him even more power to expand a purge that has seen an estimated 60,000 people either arrested or suspended from their jobs. VOA Europe correspondent Luis Ramirez reports from Istanbul.
    Video

    Video Calm the Waters: US Doubles Down Diplomatic Efforts in ASEAN Meetings

    The United States is redoubling diplomatic efforts and looking to upcoming regional meetings to calm the waters after an international tribunal invalidated the legal basis of Beijing's extensive claims in the South China Sea. VOA State Department correspondent Nike Ching has the story.
    Video

    Video Four Brother Goats Arrive in Brooklyn on a Mission

    While it's unusual to see farm animals in cities, it's become familiar for residents of Brooklyn, New York, to see a little herd of goats. Unlike gas-powered mowing equipment, goats remove invasive weeds quietly and without adding more pollution to the air. As Faiza Elmasry tells us, this is a pilot program and if it proves to be successful, the goat gardener program will be extended to other areas of New York. Faith Lapidus narrates.
    Video

    Video Scientists in Poland Race to Save Honeybees

    Honeybees are in danger worldwide. Causes of what's known as colony collapse disorder range from pesticides and loss of habitat to infections. But scientists in Poland say they are on track to finding a cure for one of the diseases. VOA’s George Putic reports.
    Video

    Video Wall Already Runs Along Parts of US-Mexico Border

    The Republican Party’s presidential nominee, Donald Trump, gained the support of many voters by saying he would build a wall to keep undocumented immigrants and drugs from coming across the border from Mexico. Critics have called his idea impractical and offensive to Mexico, while supporters say such a bold approach is needed to control the border. VOA’s Greg Flakus has more from the border town of Nogales, Arizona.
    Video

    Video New HIV Tests Emphasize Rapid Results

    As the global fight against AIDS intensifies, activists have placed increasing importance on getting people to know their HIV status. Some companies are developing new HIV testing methods designed to be quick, easy and accurate. Thuso Khumalo looks at the latest methods, presented at the International AIDS conference in Durban, South Africa.
    Video

    Video African Youth with HIV Urge More Support

    HIV, the virus that causes AIDS, is the top killer of teens in sub-Saharan Africa. But many youths say their experience with the virus is unique and needs to be addressed differently than the adult epidemic. VOA South African Correspondent Anita Powell reports.
    Video

    Video Pop-Up Art Comes to Your Living Room, Backyard and Elsewhere

    Around the world, independent artists and musicians wrestle with a common problem: where to exhibit or perform? Traditional spaces such as museums and galleries are reserved for bigger names, and renting a space is not feasible for many. Enter ArtsUp, which connects artists with venue owners. Whether it’s a living room, restaurant, office or even a boat, pop-up events are bringing music and art to unexpected places. Tina Trinh has more.
    Video

    Video Scotland’s Booming Whisky Industry Fears Brexit Hangover

    After Britain’s vote to leave the European Union, Scotland’s government wants to break away from the United Kingdom – fearing the nation’s exports are at risk. Among the biggest of these is whisky. Henry Ridgwell reports on a time of turmoil for those involved in the ancient art of distilling Scotland’s most famous product.

    Special Report

    Adrift The Invisible African Diaspora