Here to stay

The Gazette Editorial Board

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On Tuesday, the Health Insurance Marketplace created by the Affordable Care Act, better known as Obamacare, opens for business. Americans in need of health insurance coverage can begin the process of shopping for private insurance plans. Government help will be offered to many to cover premiums.

If you've been watching the endless, pitched political battle that still swirls around the health care law, you might think Oct. 1 is doomsday. Some of our national leaders have even called for shutting down the federal government to keep Obamacare from arriving. U.S. House Republicans have voted so many times to repeal the law that some polls have shown that a sizable chunk of Americans think the ACA actually has been scrapped.

But instead of bickering politicos, we're following the lead of the largest health care providers in our region. Among the leaders of the University of Iowa Hospitals and Clinics, Mercy Medical Center and Unity Point Health-St. Luke's Hospital, the new marketplace is being greeted with optimism, tempered by considerable uncertainty.

“We think it will be good for Iowa at the end of all this,” said Dr. Jean Robillard, UIHC vice president for medical affairs, who calls the act “the most dramatic change in health care since Medicaid.”

“The sky's not going to fall,” said Ted Townsend, CEO at St. Luke's.

They also believe that, ultimately, efforts to scrap the law will fail. “We're of the belief that it is here to stay,” said Tim Charles, CEO at Mercy.

TIME TO CHOOSE

The Iowa Insurance Division estimates that 244.000 Iowans are uninsured. In Eastern Iowa, consumers who buy insurance through the marketplace will have three choices: CoOportunity Health, Coventry Health Care of Iowa and Gunderson Health Plan. Each insurance provider will offer a series of different plans at different premium levels. All plans must provide a baseline level of coverage, including outpatient and emergency services, hospital stays, prescriptions, mental health and substance abuse treatment and preventive care, among other services.

The enrollment period lasts from Oct. 1 to March 31, so Iowans have ample time to shop carefully for the plan that best fits their needs. We'd urge Iowans to take full advantage of that long window for shopping.

Mercy and UIHC are partnering with CoOportunity Health, while St. Luke's has forged an alliance with Coventry. Consumers who, for example, sign up with CoOportunity and receive care from Mercy or UIHC's network of providers would pay lower premiums than if they sought care outside the alliance.

According to sample rates released by the Iowa Insurance Division, a 21-year-old non-smoker who bought a “silver” level policy from CoOportunity and stayed in its provider network would pay $199.42 monthly. If the same person went outside the network for care, his or her premium would be $246.46. So with more choice comes higher prices.

IOWA PREMIUMS LOWER

The good news is that Iowa's preliminary premiums are among the nation's lowest. And Iowans with incomes below 400 percent of poverty, or $92,200 for a family of four, will be eligible for federal premium subsidies.

Despite all the partnering and preparing, big uncertainties remain. Townsend said his institution is bracing for the possibility of an influx of newly insured patients with a pent-up demand for care, which could severely strain resources. There's also uncertainty surrounding the Iowa Health and Wellness program, which provides Medicaid and marketplace subsidies to low-income Iowans. People currently covered by the expiring Iowa Care program will have to re-enroll in the new program, which has yet to be approved by the federal Department of Health and Human Services.

In the long run, after an expected rocky start, health care leaders believe the new system will benefit consumers.

BIGGEST CHANGE

Perhaps the biggest change is a health insurance industry that once profited by deftly avoiding risk, by refusing to cover sick people and those with pre-existing conditions, and by placing tight limits on benefits, now must insure everyone. Under such a system, these providers contend that competition in cost and the quality of care will replace risk.

“What's about to happen, people will never be disqualified, never be asked a medical question to get health insurance,” said Cliff Gold, director and chief operating officer at CoOportunity. He compares the marketplace to a mall food court, where consumers have the power to choose what they want.

In that competitive environment, Townsend said he believes hospitals will have to do more to measure patient satisfaction, safety and other aspects of quality, and make that data available to consumers.

“There will be more transparency,” Townsend said. “And it will lead to a better consumer market in the long run.”

Clearly, it will take time to judge whether the health insurance marketplaces are working as intended. But we share the cautious optimism of these providers that the tumult caused by these big changes ultimately can lead to a system that increases competition and benefits Iowans.

We also believe the law is here to stay, although, like any massive piece of legislation, it contains flaws. We'd like to see Congress drop its dead-end fight over repeal and get to work fixing those flaws and fine-tuning the law.

Comments: editorial@thegazette.com or (319) 398-8262