Iowans already experience health care reform provisions

In between college and full-time work, Alex Hall became one of 2.5 million young adults added to a parent's health insurance policy since that portion of the Affordable Care Act took effect.

“Without a full-time job, he would have gone uncovered,” said his father, Jim Hall of Cedar Rapids.

As co-owners of Rehab Management Services, a medical billing company, Hall and his wife, Beth Hall, are well aware of the risks of going without health insurance.

The two welcomed the chance to keep Alex, 21 and now working full-time, on their family policy.

Allowing adult children up to age 26 to remain on a parent's insurance policy was one of several provisions that have taken effect under the Affordable Care Act.

More changes are on the way, with major ones - federal or state-run health insurance exchanges and expanded coverage for 32 million more Americans - coming in 2014.

The Affordable Care Act, passed by Congress and signed by President Barack Obama in March 2010, has been in the spotlight as Republican presidential candidates have campaigned in Iowa and elsewhere. All of the candidates have sworn to repeal the law.

Health care leaders in the Corridor are looking to this spring, when the Supreme Court will issue a ruling on the individual mandate requiring Americans to have health coverage.

Regardless of that outcome, they said, other parts of the law are already in the works.

IowaCare changes

University of Iowa Hospitals and Clinics in Iowa City is part of a recent change in IowaCare, the state's health care program for adults not eligible for Medicaid who cannot afford insurance.

UI Vice President for Medical Affairs Jean Robillard said IowaCare patients can now find primary care in five regions of the state, rather than traveling to Iowa City, one of just two previous sites along with Broadlawns in Des Moines. UI Hospitals remains one of those “medical home” providers.

IowaCare will completely disappear when the insurance exchanges take effect and those patients join Medicaid rolls or the exchange, he said, noting that 100,000 more Iowans are expected to be in the Medicaid program.

Robillard expects the change to be revenue-neutral for the hospital.

He applauded the Affordable Care Act's emphasis on preventive care, but said it could take 10 to 15 years to see the impact of those provisions.

“It's a change of culture,” Robillard said.

More people to be covered

Mercy Iowa City expects about 11,000 more people in its service area to have health care coverage once reform fully takes effect.

About 50 percent of Mercy's patients are in the Medicare program, spokesman Tim Ahlers noted.

To prepare for expanded coverage and payment reductions, he said, Mercy is focusing on quality of care and patient satisfaction.

For example, Mercy monitors procedures in areas such as congestive heart failure and pneumonia, looking for improvements.

The hospital also provides health screenings at schools and businesses, reflecting the law's prevention emphasis, Ahlers said.

In Cedar Rapids, Mercy Medical Center CEO Tim Charles said the hospital is considering investing a considerable amount of money in a new system that would allow health care systems to easily “speak” to one another.

Different electronic health records currently don't allow that interface, he said.

Ultimately, all of Cedar Rapids could be on a system to also allow shared information with hospitals and clinics in Iowa City, Charles said.

“This is probably the single most important investment that health care systems are making today,” he said, adding that the systems are one component of providing care across the continuum of a person's life.

Ted Townsend, CEO of St. Luke's Hospital in Cedar Rapids, said hospitals have long used electronic records, but the Affordable Care Act offered incentives for more doctor's offices to implement the systems.

Townsend said one of the directions of the law is value-based purchasing, in which providers are paid by outcomes, rather than volume.

Iowa Health System, of which St. Luke's is a member, has a pilot project for one of the first Accountable Care Organizations in the nation in Fort Dodge.

Townsend said the site, the only one in Iowa and one of 32 nationwide, will be a model for rural states across the country, working to provide Medicare beneficiaries with high quality care, while reducing expenditure growth through better coordinated care.

On an individual level, Townsend noted that he was reminded of the Affordable Care Act at his last annual physical when he wasn't charged a co-payment.

Preventive care visits, with no co-pays, are one of the provisions that went into effect for many Americans enrolled in job-related health plans or individual health insurance policies.

• Nearly all 44 million Medicare beneficiaries, including 427,000 in Iowa, can now receive free preventive services - like mammograms and colonoscopies - and a free annual wellness visit.

•  Also, more than 46,015 Iowa residents who hit the Medicare prescription drug coverage gap known as the "doughnut hole" receive $250 tax-free rebates, and will receive a 50 percent discount on brand-name prescription drugs when they hit the doughnut hole this year.

•  Adult children up to age 26 can remain on their parents' insurance. From the time the provision took effect in September 2010 until June 2011, the percentage of adults aged 19 to 25 with insurance coverage increased from 64 percent to 73 percent nationwide. In Iowa, 25,700 young adults became eligible to continue receiving coverage.

•  New rules prevent insurance companies from denying coverage to children under the age of 19 because of a pre-existing condition. Up to 90,000 children will no longer have certain benefits not covered because of a pre-existing condition.

• Insurance companies can no longer put a lifetime limit on the amount of coverage enrollees receive.

• Services like mammograms, colonoscopies, immunizations, prenatal and new baby care are now covered, and insurance companies are prohibited from charging deductibles, co-payments or coinsurance.

•  Americans are guaranteed the right to appeal insurance company decisions to an independent third party.

• Consumers have a choice of primary care provider within the plan's network of doctors.

• The law provides $40 billion of tax credits to up to 4 million small businesses, including up to 57,216 in Iowa, to help offset the costs of purchasing coverage for their employees and make premiums more affordable.

• Americans without health insurance will be able to buy health coverage through state-based exchanges.

• Individuals will be required to purchase insurance that covers essential health benefits or pay a fee. The U.S. Supreme Court is to rule this spring on whether the requirement in constitutional.

•  Health insurance companies will no longer be able to refuse coverage or charge higher premiums because of a pre-existing condition, including a disability.

•  Health insurance policies will be required to cover essential benefits for Americans such as emergency room visits, prescriptions and lab services.

Sources: www.whitehouse.gov, National Center for Health Statistics and

www.heathcareandyou.org; content by Cindy Hadish/The Gazette;