Health care industry braces for new law’s impact

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Dayton Daily News health care reporter Randy Tucker is taking a closer look at how the Affordable Care Act affects you. Our series answers frequently asked questions, as well as look at how the uninsured, self-employed, the health care industry and businesses are impacted by the changes.

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Oct. 6, Your Guide: The Affordable Care Act is a special section with everything you need to know about the changes and how they will affect you.

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If health care reform works according to plan, a tidal wave of new patients will hit physician practices, pharmacies, insurance agencies, hospitals and other health care providers across the state.

About 83,000 of the estimated 1.5 million uninsured Ohioans are expected to sign up for coverage next year on the state’s Health Insurance Marketplace — the centerpiece of the Patient Protection and Affordable Care Act, which will offer subsidized health insurance to millions of Americans who have had little or no access to health care in the past.

“That’s a lot of opportunity,” said Phil Parks, vice president of marketing at the Wagner Insurance Agency in Dayton. “I think what you’re seeing today is people who have been selling insurance for a long time who see the opportunity and are gearing up and getting ready.”

Consumers do not need an insurance agent to sign up for coverage in the marketplace, but a licensed agent or broker can help them navigate the system and sign up for coverage and receive a commission on the monthly premium from the insurer, Parks said.

He said most people signing up for insurance for the first time will need help dealing with the paperwork and administrative hassles that go along with buying insurance and filing claims.

“We can answer all their questions and do all the things we were trained to do when we got into the insurance business,” Parks said. “We think that will be an invaluable service that people are going to turn to us for.

“Depending on the numbers that come in, we could very quickly find it necessary to add people to our health division,” he said.

Once they have health insurance, many new enrollees are expected to head to the doctor as soon as they can.

Springfield resident Mendelynn Fisher, 62, said she has not been able to afford health insurance in the past on her Social Security survivors benefits.

But she’s anxious to see what her options might be on the health insurance exchange — where she would likely eligible for a generous federal subsidy to help pay for coverage — and has already made plans to see a doctor.

“I haven’t had blood work done in six or seven years,” Fisher said. “I feel fine. I don’t have any symptoms of anything. But I’m a smoker, and you never know.

“I’m already thinking about making an appointment this fall because I feel like a lot of people are going to be making appointments by the time you can go see a doctor next year,” she said.

The marketplace’s six-month enrollment period begins Tuesday with coverage starting Jan. 1.

But nobody knows for sure exactly how many people will enroll, and that has given some health care providers reason for pause.

“We’re not making preparations for a huge increase in volume at this point,” said Terri Day, president of Kettering Health Network. “But if we see that and it starts to go that way, we certainly can accommodate that.”

She said increased coverage under the health care law would affect all segments of the health care network, including outpatient sites, primary care offices and urgent care facilities.

But while the hospital is maintaining “flexible” staffing levels, how that staff will be deployed or augmented won’t be determined until after the health care law is fully implemented next year.

Many hospitals are in the same boat and unsure of how they’ll be affected by the health care law. But one thing is certain: “It will no longer be business as usual,” said Bryan Bucklew, president and chief executive of the Greater Dayton Area Hospital Association.

That’s because the health care law will change fundamentally the way hospitals operate by tying government reimbursements to reducing hospital re-admissions and providing better chronic disease care to reduce the number of overall admissions.

“For years, the primary objective of hospitals was to put butts in beds,” Bucklew said. “Now, it has shifted almost 180 degrees. Only people that need to be going to the hospital should be going to the hospital. It’s paradigm shift.”

Still, the health care law will open a variety of opportunities throughout the health care system, in many cases staring with primary care doctors, said Dr. Donald Nguyen, a Dayton-area pediatrician and state director for Doctors for America — a national group of doctors and medical students that support health care reform.

“As doctors, we’re preparing for increased demand, but it’s not like it’s going to happen all at once,” Nguyen said. “Everybody who gets insurance isn’t going to make an appoint to see a doctor on the same day. But people who have insurance will no longer be reluctant to go see a doctor, and that’s where you will see steady and growing demand for our services.”

Expanded insurance coverage under the health care law is likely to boost and already robust health care industry in the Dayton area.

Locally, health care accounted for about 13 percent of all workers employed in the Dayton metro area in the first half of this year, according to a recent Brookings Institution’s “Metro Monitor” report.

By comparison, employment in the top 300 metro areas varied from just 7 percent of total employment in the Las Vegas metro area to 20 percent in the McAllen, Texas, metro area, Brookings found.

“Health care has become an essential industry in this area,” said Chris Kershner, vice president of public policy and economic development for the Dayton Area Chamber of Commerce. “As they (health car providers) continue to have success, the region will continue to be successful.”