The head of one of Oregon's largest health insurance companies said the early months of Affordable Care Act enrollment were simply the opening rounds.
"We've gone through phase one, wave one," said Angela Dowling, president of Regence BlueCross BlueShield of Oregon. "To get it off the ground, get the education, get the people to understand it and to get people really to embrace conceptually what this means."
Speaking to The Chamber of Medford/Jackson County at its monthly forum at the Rogue Valley Country Club, Dowling said just 10 percent of the previously uninsured population has enrolled.
"We've seen a slight uptick in coverage, and that's not a huge push, frankly," she said. "Wave two will be, 'How do we pay for it?'"‰" I don't have the answers to paying, but I do know we have not heard the end of it."
She said her industry hasn't done a good job of teaching customers how to access care.
"You go to a provider, get a diagnosis and then you move forward and get your treatment," Dowling said. "Often we don't teach the consumer what that means."
The industry needs to better assist clients in finding a provider and where to go for second opinions, she said.
Dowling used the cost for a laminectomy — a type of back surgery used to relieve compression on the spinal cord — to explain the possibilities. Assuming an employee has a $500 deductible and insurance pays for 80 percent of the cost after that, the average cost for having the operation in Portland would be $18,500, with $4,100 out-of-pocket-costs. In Salem, the same procedure would cost $11,500, with $2,700 coming out of pocket. In Medford, the operation runs $6,000, with out-of-pocket costs of $1,600.
"That's a significant difference for both the insurance company and employee," she said.
Whether it's a laminectomy, tonsillectomy or heart surgery, she said, the costs can vary greatly.
"What we haven't done as a consumer population is to learn how you shop for that coverage," Dowling said. "If you go to buy a car, what do you do? You shop. If you are my husband, you whip out Consumer Reports, and you do a whole algorithm."
During the question period, Dowling was asked if accelerated enrollment by people who need subsidies will affect sustainability of the program. She said the assumption by ACA designers was that only a third of the 7.2 million ACA enrollees would be eligible for subsidies. The actual figure to this point, however, is 79 percent.
"The good news is that we didn't get 7.2 million (nationwide)," she said. "So far we've only gotten 3 million. That should offset it a little bit, but at some point the remaining 4 million will enroll, it's just a matter of communication, education and getting that message out there. At that point, hopefully, the scales will balance and not everybody will be subsidy-eligible."
She said there will be more political debate.
"When they built the actuarial models in 2010, this was the assumption," Dowling said, referring to the predicted lower numbers of subsidized enrollees. "Now it hasn't played out the way we expected either on a national or local basis. I don't have a crystal ball. I can't tell you it will be sustainable or won't be sustainable. I can tell you, though, we have not heard the end of this."