County to Proceed Gingerly Toward Implementing Phase One of Obamacare
November 6, 2012
Despite the financial exposure Natividad Medical Center could face in offering insurance coverage to up to 1,500 low-income, uninsured residents, the Monterey County Board of Supervisors Tuesday directed Natividad CEO Harry Weis to proceed with concrete steps toward implementing such a plan.
Weis will ask state officials to approve some tweaks to the plan, namely language affirming that expanded local coverage won't jeopardize the county's chances to collect state funds allocated for health care.
"We believe we give them additional ammunition when they see all the ways we’ve quietly tried [to expand coverage]," Weis says. "They could use that effort against us rather than help us."
SEIU organizer Erik Larsen praised the board's direction. "The board's action today gets us one step closer to a low-income health program for Monterey County," he writes by email.
The county is one of eight in California that's lagged in launching a bridge plan for the Affordable Care Act (aka Obamacare) that takes effect on Jan. 1, 2014. The temporary plan, ViaCare, would cover 1,000 to 1,500 uninsured county residents at or below the poverty line, at a total cost of $12-14 million. Until Obamacare launches fully in 2014, there's a 50-percent reimbursement, so the county would be on the hook for some $6-7 million. (After 2014, ViaCare patients roll over to expanded Medical, at which point the feds will cover those insurance costs in full.)
Weis is also worried that providing coverage to uninsured patients could mean declines in an already costly public coverage plan for the uninsured.
In an Oct. 31 memo, he laid out the financial risks the county could face in providing expanded coverage. Projections show Natividad losing $21 million this year on providing care to the uninsured, a figure that's doubled since 2006. The hospital makes up most of that deficit from patients who have commercial insurance coverage, but Weis worries about a widening gap.
Today, about 15 percent of Natividad patients have commercial insurance coverage, and about 65 percent have some form of public coverage. About 20 percent are uninsured, which Weis expects to be reduced to 10 percent after the Affordable Care Act takes effect.
Considering the overall impact Obamacare will have to Natividad, as more patients get insurance coverage—either through expanded Medical or by purchasing commercial plans off the state exchange—Weis says, "We think it should tilt slightly more positive than negative."