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Agnesian HealthCare panel works to ‘demystify’ healthcare insurance reform
November 27, 2013

Questions came fast and furious during a special panel discussion on healthcare reform from Fond du Lac area participants concerned if they have appropriate insurance starting January 1, 2014.

Agnesian HealthCare’s Journeys: a health resource center welcomed more than 100 individuals at a recent educational program to help them better understand the Affordable Care Act and its effects. A panel of Agnesian HealthCare experts fielded numerous questions for more than one hour.

“The Affordable Care Act is absolutely the single largest reformation of our healthcare delivery system that we’ve had since Medicare and Medicaid came about in the late 70s and 80s,” says Steve Little, Agnesian HealthCare president and chief executive officer.

Little shared the three components to healthcare reform.

“First, there is delivery reform, meaning that as healthcare delivery people we are changing the way we deliver the care to you,” Little explains. “You’ll see some things as it relates to wellness and preventive medicine, and coordination of care. The second piece of it is payment reform. It’s been said that we don’t have a federal budget problem; we have a healthcare problem. We’re trying to figure out how to accept different models of payment and also less payment for doing the same amount of work and also taking on more risk.

“The third component is insurance reform,” Little adds. “That’s the piece that impacts all of us as individuals the most. The law itself requires individuals to have some forms of health insurance. It also requires insurance companies and employers to provide insurance or they may face monetary penalties.”

The key elements of healthcare insurance reform require insurance providers or self-funded employers to provide free preventive care. “On the surface, that is a good thing,” says Little. “That provides for wellness checks and regular diagnostic screenings (like colonoscopies and mammography). The bad thing is who pays for it, and that’s a concern. As more services are added, the cost of insurance is rising.”

The individual mandate requires that all individuals have some form of insurance, whether through an employer, the independent marketplace or through the federal marketplace.

It also includes a patient bill of rights, which opens up preventive care services to children and adults – immunizations, screenings, counseling, newborn care. Medicare-aged individuals are also entitled to preventive services whether directly through Medicare Part A or a Medicare Advantage plan.

For individuals that decide that for whatever reason they don’t want to have insurance, they will pay a penalty, which will be enforced by the Internal Revenue Service when tax returns are filed for 2014.

The health insurance marketplace is intended to provide individuals with an alternative to find insurance. There are credits or rebates available for those who qualify based on income levels. Fond du Lac County residents have the choice of five different company plans. There are four different insurance plan categories – bronze, silver, gold and platinum. Prices increase moving up to the platinum level.

When asked how the Affordable Care Act impacts provider care, Derek Colmenares, MD, Agnesian HealthCare chief medical officer, says, “The care is going to be there,” he says. “The Affordable Care Act helps provide more options for a provider and patient to consider, especially when in the past coverage has been limited based on available insurance. As providers, we will always talk honestly with our patients and conversations will remain as important as they are now.”

There are three ways to apply: on-line, mail or in person. Agnesian HealthCare offers certified application counselors to help interested individuals. Appointments can be made by calling (920) 926-4841 (Fond du Lac) or (920) 324-6540 (Waupun). Insurance agents can also offer advice.

Other panelists included: Rita Meidam; Anna Kaniess and Kathy Donahue, certified application counselors; Barb Faber; and Jennifer Burgess and Amanda Schumacher, nurse practitioners.

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