Last night, a group of Berkeley and Jefferson county chiropractors met informally to discuss the impact the Affordable Healthcare Act will have on patient care in their line of business. The topics of discussion included the increase in premium, deductible and co-pay amounts, the gap in service charges versus reimbursement, and the long waiting lists for basic care not meeting a patient’s current medical needs.
According to PriceWaterhouseCooper, in an updated state-by-state map graphic, West Virginians currently participating in the Affordable Healthcare Act are paying a 6.7-9.9% increase in their premium rates from 2013 enrollment. The average family premium is now $435 per month. This is higher than the national increase of 5.4% with an average rate of $389.
This does not include the 10-40% of the deductible and co-pays still coming out of the patient’s pocket according to the specifics of his/her plan. With the metal plans (bronze to platinum) tiered according to coverage and put of pocket expenses, the average family can pay $3-710-12,569 per year for medical care, in addition to their premium rates.
The $5,081 single person deductible for the bronze plan increased 42% from $3,589 in 2013 while the platinum plan decreased almost 90% and has the highest percentage rate (41.35%) of having a zero cost deductible rate. However, the gold and platinum plan is available only for people with incomes at least 250% above poverty rate. With over 14% of families and individuals at or under poverty level and an average annual income only 116% (for a family of four) above poverty level, most West Virginians will not benefit from these plans and the reduction in deductible.
Because a large part of the population of the state is impoverished, more than a quarter of residents participate in Medicaid or CHIP programs. This enables most people to receive medical care for little or no out of pocket cost to the patient. However, it becomes a problem when a patient needs to find a participating provider. Many physicians opt out of participating with Medicaid due to its low reimbursement rate. An out-of-network provider will cost the patient out-of-pocket expenses, since no insurance coverage would be available.
A relevant example would be the reimbursement rate for chiropractic adjustments. A patient prescribed an adjustment plan receiving 12 adjustments over a four week span would be charged, on average, $825. Medicaid would only reimburse $300 for all services rendered, covering over 36% of the actual cost of treatment. Because the discrepancy is so large, many providers cannot afford to take Medicaid patients and cover their practice’s expenses.
Another issues commonly faced by patients participating in Medicaid and CHIP is the long waiting lists to be seen by a provider. The few participating providers are being bombarded by patients’ needs, causing a waiting list for a specialist that can leave a patient’s appointment delayed six months or more.
An example would be a patient who was referred to a gastroenterologist for a routine colonoscopy to determine gluten intolerance. This patient, a Medicaid participant who chose to pay out of pocket for chiropractic and functional medicine, was placed on a six month waiting list for this procedure to be done by the only local Medicaid participating specialist. Because of the severity of the case, the patient eventually opted for traveling several hours to another participating specialist with a waiting list of only three months.
Overall, The Affordable Healthcare Act and Medicaid Extension has not been beneficial to West Virginia residents. While it has enabled more residents to obtain health insurance, current out-of-pocket, out-of-network and deductibles stress an already fragile economic state. Low reimbursement rates cause many providers to opt out of Medicaid, leaving many West Virginians few choices in medical care. The few participating physicians currently have long waiting lists, overcrowded waiting rooms and little time to effectively see to their patients’ medical needs. The current Affordable Care Act simply does not effectively take care of the people for which it was designed.