After nearly three years of speculation, political chatter and promises that may or may not be fulfilled, the Patient Protection and Affordable Care Act, otherwise known as "Obamacare," is coming to Jackson County.
On Tuesday, the state's online health insurance exchange, Cover Oregon, will open for business — the first in a series of important milestones that will move along the reforms passed by the U.S. Congress in March 2010.
Oct. 1: Open-enrollment period begins for state insurance marketplaces, including Cover Oregon, which means you can start shopping or buying health insurance for next year.
Jan. 1, 2014: Date when insurance coverage purchased through Cover Oregon will become effective.
March 31, 2014: By this date you must have health insurance or face a penalty. It is also the close of the open-enrollment period that began Oct. 1, so if you don't have insurance by then, you can't buy through the online marketplace until Oct. 1, 2014 — unless you have a significant change in your life situation, such as marriage.
It might seem like a sudden change in the health care landscape to most of us, but the local medical establishment has been working steadily the past three years to prepare for this day and make the transition as seamless as possible for patients — many of whom will find themselves with health insurance for the first time in their lives.
At the end of the day, the only question that matters is: Will this work?
The short answer, based on interviews with local health care providers, is: Hopefully. But no one can say for sure.
"What we do know," said Dr. Robert Thompson, the chief quality and medical officer for Asante Rogue Regional Medical Center, "is that the way business has been done in the past, with the health care cost curve bending upwards to a point where it is not sustainable, has to be fixed."
Whether Obamacare will bend the curve in a more beneficial direction has yet to be seen.
What is known is that a major component of the reforms will kick off Tuesday when Cover Oregon goes live.
Cover Oregon — known as a health insurance marketplace — was designed to allow people to buy health insurance that will take effect on Jan. 1, 2014. However, the website won't be open to the general public until Oct. 15.
For the first two weeks, in order to buy insurance, visitors to the site (www.coveroregon.com) will have to be accompanied by an insurance agent or a "community partner" who has undergone training designed to help navigate people through the system.
On Oct. 15, the website is scheduled to open for anyone seeking to buy private insurance. The website will feature a list of eight private carriers — each offering a range of plans — allowing people to compare coverage options and prices.
Whether this goes off without a hitch remains to be seen. Approximately 500,000 Oregonians are uninsured, according to the Oregon Health Authority. If a significant number of these people rush to the exchange, it could cause system glitches or an all-out crash.
Oregon residents will have until March 31, 2014, to purchase insurance on the exchange or face a financial penalty because of a federal mandate to buy insurance.
In the first year, this penalty is about $95 or 1 percent of your adjusted gross income, whichever is greater. However, the penalty will increase dramatically over the next three years.
Many people will surely chafe under a government order to purchase insurance. Robin Mishler, of Medford, certainly does.
"It's just more government interference," Mishler said. "I don't think the government should be so involved with heath care."
However, Mishler, who has had trouble getting insurance because of severe osteoarthritis, which qualifies as a pre-existing condition and allowed insurance companies to deny her coverage prior to the health care reforms that ban such actions, said that something needed to be done to correct the problems of the insurance industry.
"I also think (the health care reform) could slow the tide of health care costs that's hurting the country," Mishler said.
Meanwhile, local hospitals have spent the past few years gearing up for the health care overhaul. The primary message from Asante Rogue Regional Medical Center and Providence Medford Medical Center is that the hospital experience won't dramatically change for most people.
The goal, however, for each hospital is to tame high readmission rates among chronically sick people — which they must do or suffer stringent penalties by the federal government.
These penalties will come in the form of reduced Medicare reimbursements, something hospitals would like to avoid.
"What we are focused on now is treating anyone who needs the emergency room," Cindy Mayo, CEO of the Southern Oregon service area for Providence. "We certainly won't turn anyone away from the ER. But after they are treated, we want to direct them to a primary care physician or another provider in the community who will help this person stay healthy and out of the ER."
Providence now employs a guide in the emergency room to coach patients on options that could keep them from returning to the ER time and again.
This guide will help a patient sign up for insurance on Cover Oregon, where he or she might qualify for the Oregon Health Plan or receive significant financial assistance to afford insurance.
"We see some patients multiple times a month for the same issue," said Kelly Barton, an ER social worker with Providence. "What we want them to learn is the ER is not for long-term care. It's a starting point for care."
For instance, a patient might frequent the ER for dental pain. The ER guide will meet with him to see whether he can attain coverage under the exchange. Then the guide would help him make an appointment with an organization such as La Clinica, which assists many OHP patients, to receive dental care that may permanently solve the medical issue and keep him from coming back to the ER unnecessarily.
Providence spokeswoman Hillary Brown said about 20 percent of the hospital's ER visitors are uninsured.
"We hope that over the next year or so this percentage will drop," she said. "We are not expecting a sudden drop, but as people become educated to the options they have, we will see the number of uninsured people lowered."
Thompson, of RRMC, said his hospital has been hard at work preparing for a mass of patients who will suddenly have insurance or OHP coverage in the coming years.
The Oregon Health Authority estimates that 16,000 additional people in Jackson County will be eligible for coverage under the OHP by 2016.
And a lot of these people will be in quite bad shape by the time they enter the hospital for treatment.
"Some of these patients have never had insurance in their lives," Thompson said. "There is a lot of pent-up demand that we are anticipating."
RRMC has been adding doctors at a steady clip in recent months and hopes to have 60 to 80 new primary care physicians in place in the next two years to handle the increased workload.
The key, as Thompson points out, is to deal with the sickest 10 percent of the population who account for 65 percent of health care expenses.
"We are not going to be caught flat-footed on this," Thompson said. "We want to treat these people and keep them out of the hospital."
Thompson said there are still concerns about the reforms that might need to be addressed. For instance, if too few younger, healthy people forgo the insurance exchange, then the pool will be weighted more heavily toward older, sicker people, which has the potential to send the entire system crashing into insolvency.
This is where people such as Lynnette Robben of La Clinica come into play. Robben's job is to spread the word throughout the community about the benefits of the reforms. She has been trained to help people navigate the exchange to see whether they qualify for the OHP or financial help purchasing private insurance.
People who earn up to 138 percent of the federal poverty limit will qualify for the Oregon Health Plan. People who earn between 139 and 400 percent of the poverty level can qualify for subsidies that will reduce their insurance premiums.
"People aren't really sure what this reform means for them," Robben said. "It's just a matter of getting the word out."
For some health care providers, the reforms were being felt prior to the Oct. 1 exchange opening.
Rita Sullivan, director of OnTrack Addiction Recovery Programs and Services, said her agency is seeing more referrals from doctors ushering their patients into drug and alcohol treatment.
In the past, Sullivan said, addictions treatment specialists rarely sat at the table with primary care doctors. That has changed under an approach called coordinated care, in which doctors, dentists, mental health providers, social service agencies and others work together to increase efficiency, reduce costs and make sure people get the care they need. The reforms require that regional coordinated care organizations include a mental health and drug/alcohol treatment component, and coverage for that treatment is considered one of the "10 essential benefits" that all insurance plans must cover.
"We feel like we are now being brought into the process," Sullivan said.
Many of OnTrack's clients are low-income and have gone without insurance for years. They tend to use the ER as a primary care resource, creating an expensive inefficiency in the health care system. When these patients are unable to pay for their treatment, or if they don't have insurance, then the cost is spread out to the general population in the form of higher medical costs.
"If drug and alcohol treatment and the physical health doctors and mental health all work together, it's more effective than doing it by ourselves," Sullivan said.
Changes like this are being made all across the local health scene, because while most people are focusing on the launch of mandatory health insurance, the health reform law is not aimed just at getting people insured. It's also aimed at improving the care they receive and reducing the cost of delivery. That's why coordinated care organizations are being launched, doctors are being hired, ER guides are being trained, clinics like La Clinica are adding dentists and surgeons are getting serious about educating their patients about diet and exercise, along with dozens of other initiatives launched by local doctors and hospitals.
The sentiment among many in the medical field and the patients they serve may be summarized by Barbara Brown, a Medford real estate broker.
"I am looking forward and hoping that this new system will offer me more options for health care insurance and hopefully lower costs," she said.
Time will tell whether these hopes come to pass.
Reach reporter Chris Conrad at 541-776-4471 or firstname.lastname@example.org.