What's the word on the Affordable Care Act three years in?

Colorado insurers, hospitals and residents weigh in on the ACA

As the Affordable Care Act (ACA) enters its third year of availability in Colorado, the effects on those touched by the legislation are myriad, complex and still shifting. So what do residents and institutions have to say about the program, particularly as we enter an election year?

To be clear, Connect for Health Colorado officials maintain that the program is a success in the state. Connect for Health Colorado is the public, nonprofit entity established by the Colorado General Assembly in 2011 to create the ACA’s insurance marketplace in the state.

In its most recent enrollment period, Connect for Health Colorado said 211,579 Coloradans enrolled for 2016 health coverage, either in private health insurance, through Medicaid or Child Health Plan Plus (CHP+). That number is up from the 141,639 people who signed up in the year-ago period.

“I am pleased that so many Coloradans took the important step of getting health coverage through us,” Connect for Health Colorado CEO Kevin Patterson says of the figures.

 Here is what others in Colorado are saying about the ACA, three years in:

Jandel Allen-Davis, VP of government, external relations and research for the Colorado region of Kaiser Permanente, one of the nation’s largest not-for-profit health plans:

 “This Act touched every aspect of our business,” Allen-Davis says, explaining that she or someone on her team has worked on it daily since Congress passed the initial legislation in 2010 and the Colorado exchange launched in 2013. “It really changed the nature of how we execute on our work, on how we run our business. It’s been a busy five or six years.”

 And what was the initial effect of the ACA on Kaiser Permanente in Colorado?

“The individual market is the one that really exploded, because that’s where all the people who couldn’t get coverage were,” Allen-Davis says. “It’s what I would call a volatile line of business.”

But that demand wasn’t a total surprise to Kaiser Permanente: “We anticipated there would be some volatile shifts and swings as people figured out what to purchase,” she notes.

Now, however, the market for health care in Colorado has begun to show signs of settling down. “We think we’re starting to see some decreases in high-cost utilization,” she says.

“In many, many ways, [the Affordable Care Act] has been very good. There’s gratitude that new members and patients express at being able to get services that they hadn’t gotten access to,” Allen-Davis says. “I think we’re on the road to being better off in respect to care and coverage in the United States because of the Affordable Care Act.”

But there’s much more work to be done, Allen-Davis adds, particularly in making health care more efficient and affordable. “We’re actually at the end of the beginning of health care reform,” she says. “This is a story that will be told over many more decades in the U.S.”

Jeff Helton, teacher of health economics at the University of Colorado School of Business and Metro State University of Denver, and former CFO of health systems around the country:

The ACA is “Romneycare gone wild,” Helton says. He explains that Colorado is currently seeing many of the same situations Massachusetts faced following the 2006 passage of former Gov. Mitt Romney’s health insurance reform there. In Colorado – just as in Massachusetts – the percentage of those without insurance has declined and likely will continue to drop, Helton says, adding that the current uninsured rate in Massachusetts is now around 3 percent.

“Now you’re getting access to care you didn’t have before. But the insurance that people have gotten still leaves them on the hook for quite a bit of expense,” he notes, pointing to deductibles of $5,000 or more that some may be unable to afford.

Moreover, Helton says that providers in Colorado and elsewhere are seeing a “temporary uptick in expenses” due to pent-up demand for health care from those newly covered. Further, “You have a lot of people who don’t know how to use health insurance,” he says. “A lot of these people, they haven’t really connected up with that yet. So we’ve got kind of an educational problem.”

Helton adds that some insurers are raising their rates to deal with greater-than-expected demand, just as providers initially did in Massachusetts. But he says, “There’s an expectation that some of that will level out in time,” as it has in Massachusetts.

Finally, Helton notes that the ACA is not an antidote to all of the ills that plague the nation’s health-care system. For example, health care remains more expensive in remote mountain towns of Colorado, and “the Affordable Care Act is not going to fix any of those problems. We have to manage the expectations,” he says.

Donna Blakesley, a 53-year-old resident of Arvada who suffers from Ehlers Danlos syndrome and obtained health insurance through the ACA in Colorado:

“I was going to [Metro Community Provider Network] clinics and Medicaid doctors, which, prior to the ACA, were just barely sufficient medical care,” says Blakesley, who received Social Security disability insurance through Medicare and Medicaid before enrolling in health care through Connect for Health Colorado.

“Once Obamacare came into place, immediately I was able to get Kaiser Permanente,” she says. “My doctors knew that I had an aneurysm in my aorta that needed to be surgically addressed but, prior to Obamacare, no one was able to do anything about it until it burst. It was impossible to pay for it because it was preventative surgery. So I had to let the aneurysm burst and hope that I got to the hospital in 20 minutes. As soon as I got the Kaiser Permanente through Obamacare, six weeks later I got the surgery.”

Adds Blakesley: “I don’t know a whole lot about Obamacare. I understand that for some people it’s unfortunate. I understand some people don’t like it. Personally, I think the people who dislike it the most are the people who really don’t need it. If they needed the program, they would appreciate what it’s doing. I think Obamacare has done what it needed to do for the people who needed it.”

Chris Tholen, VP of financial policy for the Colorado Hospital Association, which has worked to educate Colorado hospitals on what to expect from the ACA:

“The Affordable Care Act has had a large impact to our members,” Tholen says, noting that hospitals across Colorado recorded notably higher numbers of ER visits immediately following the implementation of the ACA in Colorado. He explained that the rise in visits was higher than many in the hospital sector had expected.

“Overnight we saw a dramatic shift,” he says. “We see much sicker patients. We see higher volumes than we saw in the past. And we continue to see those increases today.”

But, “hospitals were prepared,” he says. “We still saw hospitals able to handle the higher insured population. I think it was handled very well. For hospitals it is a positive. Why are hospitals in business? It’s to make their communities healthier.”

Adds Tholen: “The people in the community, they have better access to health care if they’re insured.” And with the ACA, “It’s allowing hospitals to do their job better and see more people.”

However, he notes the process isn’t over yet. “It takes about four years to really see the long-term impacts of seeing a physician regularly, of taking your pharmaceutical drugs on a regular basis, and getting those long-term conditions to stabilize.”

Mark Thompson, director of sales and client services for Delta Dental of Colorado, a nonprofit that provides dental insurance:

Due to the ACA, “We’ve seen an increase in the number of individuals and families that have had access and are now purchasing dental benefits,” Thompson says, explaining that Delta’s business for individuals grew three-fold from 2013 to 2015. He said individual plans now comprise about 6 percent (up from 2 percent in 2013) of Delta’s total membership – roughly 1.2 million people.

Further, Thompson says that DeltaDental is now embedding its services into the Obamacare plans offered by Kaiser Permanente and Rocky Mountain Health, per legislation, and as a result, “We have more than 35,000 children through those two medical carriers alone that prior to the Affordable Care Act were not receiving that [dental care] benefit.

  “Our mission for our organization is to improve the overall health of the communities we serve,” Thompson says.

  “We’ve felt that the Affordable Care Act … was a real opportunity to fulfill that mission.”

  And how does Delta Dental view the future of health care? “It’s a shifting market,” Thompson says. “Organizations that are able to meet the needs of their customers are going to find success in that market space. We’re committed to continuing to offer benefits and going directionally to where we need to move as well.”

BUSINESSES STRUGGLE

While supporters of the ACA point to growing numbers of insured Americans as evidence of the legislation’s success, those in the Colorado business community are less convinced.

According to a 2015 survey of roughly 300 small-business owners (those with five to 100 employees) conducted by Market Perceptions & Healthcare Research and commissioned by Delta Dental of Colorado, close to half said their benefits to employees have been impacted at least “a moderate amount.” And four out of 10 executives surveyed said their company’s employee benefits have been impacted by the ACA “a great deal.”

Importantly, fully 61 percent of the respondents who said the ACA impacted them cited increased cost as the main result of the implementation of the ACA in Colorado.

 “What we found [through this survey] is that the employers are remaining committed to offering these coverages,” said Mark Thompson, director of sales and client services for Delta Dental of Colorado. However, he said, “They’re looking for other options.”

Specifically, he said “there’s some cost shifting that’s going on,” meaning that some small-business owners are working to move the cost of health care directly to their employees.Still, according to the survey, eight in 10 employers note their commitment to offering health benefits remains unchanged, and 96 percent say employee benefits remain as or more important for recruiting and retaining employee talent.

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