The Chadds Ford Business Association gathered Thursday, May 1 for what member Peter Wells described as an “extremely remarkable summary of an extremely complicated subject.” Patrick J. Gavin, chief operating officer of Crozer Keystone Health System, shared with the CFBA an update of the Affordable Care Act and how it affects us as members of the local community.
Prior to the introduction of the Act about 50 percent of Pennsylvanians had medical insurance through employer-based coverage, around 25 percent utilized Medicare & Medicaid, and 14 percent purchased coverage directly, leaving 11 percent of Pennsylvanians uninsured, or about 1 out of every 10 patients. However, as Gavin explained, hospitals are “Insurance blind when patients are in front of them in a trauma situation. We treat everyone who walks through the door.”
To compound the situation, Pennsylvania is one of six states that have not passed a Medicaid Expansion to offer discounted assistance to uninsured residents. As a result, there is a large gap of no assistance being offered to those who need it.
Gavin said, “Pennsylvanians who are below the poverty line are eligible for coverage through Medicaid, along with those who are at 138 percernt of the federal poverty line are offered assistance in obtaining health insurance. This leaves those individuals between the poverty line and 138 percent of the poverty line, who are covered by nothing.”
Over time, this lack of insurance has created within the hospital systems what Mr. Gavin described as a “dysfunctional financial system, due to the resultant cost shifting.” Gavin was sure to point out that while this dysfunction is something that is just now being addressed, it is a situation that has been decades in the making.
Over the years, we have witnessed steadily advancing technology, medical facilities, and medical procedures. “Fifty years ago, the biggest concern was keeping tools and cloths sterilized,” Gavin said. “Now we have MRIS, Cat Scans, expensive antibiotics, etc. We are being offered great care but it comes at a great cost.”
The Affordable Health Care Act is a solution to addressing the gap in health care coverage, along with the detrimental cost shifting occurring within the hospital systems. The act will require all Americans to carry health insurance or pay a fine. The Act will also ensure that all health care providers offer 10 essential benefits to all of their customers, that individuals cannot be denied health care coverage, and that their coverage can only being cancelled due to nonpayment or fraud.
There are five different plans being offered by the act, and tax credits are being made available to help offset the costs. However, questions and comments abounded from the group as it seemed that regardless of which premium/co-pay plan was chosen, overall expense was extremely high.
Gavin reminded the group that just as the problem took half a century to accrue, so too would the solution take some time: “The aim is to correct in three to four years what it took fifty years to break.”
While open enrollment closed for 2014 on March 31, it will open again in the fall, most likely in October and will remain open for two to three months. If you have questions about the act or health care plans, Crozer Keystone Health System is offering free counseling from certified individuals to help you navigate the available health plans, and to find out how the Affordable Health Care Act affects you.
Photo: Patrick J. Gavin, chief operating officer of Crozer Keystone Health System, addresses members of the Chadds Ford Business Association.
About Sarah Gregg
Sarah Gregg relocated to Chadds Ford six years ago, but has been working for local Business Pennock Insurance for the past 10 years. When home in Chadds Ford she enjoys reading, gardening, and spending time with her Jack Russell Terriers. Her hobbies also include traveling, especially on Wine and Craft Beer tasting adventures. She enjoys volunteering, especially at the Township Recycling days, and currently serves as the Press Secretary for the Chadds Ford Business Association.
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