Fellowship Story Showcase
Health care reform should improve services in Gary
This story is Part 15 of a 15-part series that examines health care needs in Gary, Ind.
Part 8: Woman wins fight against obesity
Part 9: Diabetes 'scared me to death'
How will health care reform impact Gary and its citizens?
While the Republican-dominated U.S. House of Representatives voted to repeal the Accountable Care Act of 2010, the U.S. Senate isn’t likely to follow suit, meaning the landmark health reform legislation will continue to change the way many Americans receive health care.
Sam Flint, assistant professor of public affairs health care policy and associate director of Indiana University Northwest’s School of Public and Environment Affairs, said the new law will benefit many residents of the Steel City. Flint, the former chief procurement officer for medical and heath care services for the state of Illinois, said the new law transfers money to fund expansions of both public and private health insurance. While the new law will provide health care coverage to nearly two-thirds of Indiana’s uninsured residents, it will partly finance that expansion by reducing the amount of disproportionate share hospital funding now going to safety-net hospitals for treating the uninsured.
Methodist Hospitals in Gary has historically relied heavily on DSH money to operate, for example, $40 million in 2009 and $72 million in 2007. In theory, Flint said, Methodist will recoup some of the lost DSH money through payments from previously uninsured patients.
But the Indiana Hospital Association said Hoosier hospitals predict a 10 percent to 15 percent cut in revenues under the health reform law.
He said the health reform law also allocated $5 billion for state high-risk insurance pools. Those pools provide coverage to Hoosiers with pre-existing conditions unable to afford health insurance who have been on waiting lists for six months or more.
“Those people could get covered if Indiana chooses to apply for that money, but so far they haven’t. Many of those people live in Gary,” Flint said. “That’s a piece of the pie the state should definitely look at.”
Flint estimated that more than 500,000 Hoosiers could be covered under the health reform provisions: about 270,000 through private insurance subsidies and 270,000 from Medicaid expansions. He said a study concluded that having health coverage could save 530 Indiana lives annually of adults predicted to die prematurely without coverage, about 19,000 nationally.
Changes to drug costs, preventive care
The law also expands health insurance options for small businesses, providing tax credits for companies employing under 25 with average wages less than $50,000 annually, so some small Gary companies or family-owned businesses may now be able to afford health insurance for their employees. Starting Jan. 1, many new preventive care services are covered by Medicare, services that do not require beneficiary co-payments, meaning fewer out-of-pocket expenses for seniors.
Flint said another benefit is the cost reductions for brand-name medicines. Medicare recipients purchasing drugs will see immediate 50 percent savings that rise annually by 2.5 percent. The savings are aimed at helping those estimated one in seven seniors caught in the so-called doughnut hole who now pay higher out-of-pocket costs.
Physicians practicing in medically underserved areas should benefit by seeing a 10 percent Medicare reimbursement bonus payment, recognition of the charity care and lower Medicaid reimbursements common to inner-city physician practices. Primary care physicians in those areas will receive enhanced Medicaid reimbursements to encourage them to treat more Medicaid patients.
The new law also expands funding for the National Health Service Corps by $290 million, money used to recruit physicians to practice in medically underserved and health professional shortage areas like Gary by offering student loan repayments and forgiveness.
Community health centers also receive money to expand services, more than $11 billion over five years. Gary’s Community HealthNet has applied for some of that funding to broaden services.
Flint said it’s too early to know how some Medicare demonstration programs contained will impact health care in Gary or the hospital and physicians most affected by them. That’s because some of those programs — which generally incentivize hospitals, doctors and other providers to collaborate to improve health care quality and outcomes — have not been fully implemented.
“They’re still setting up these experiments that will move the health care system in the right direction,” he predicted. Flint said that in the 1990s when managed care became common, health care policy analysts saw that physician practices improved care for all patients even when they were incentivized only to improve care for some patients.
“Physicians do change behavior in response to payer demands and those treatment practices bleed into all the work they do,” he said.