Since the passage of the ACA in 2010, the advent of its major provisions always seemed far away. In less than 4 weeks the State or Federal Marketplaces will begin offering insurance policies to the general public, with coverage to be effective Jan. 1. Many have hoped that the political winds would shift and the entire law would be repealed. Rural providers should be preparing now for participation in the ACA regardless of hopes and desires to the contrary.
Providers should be concentrating on dicovering the Qualified Health Plans (QHP) that are going to be offered in your area. Per number 5 below, you should know in mid-September which QHP’s will be offered in your Marketplace. The next question is whether your facility has a contract with all of the QHPs in your market. If not, contact the QHP and ask to be contracted to serve those insured by that QHP. If you’re an “Essential Community Provider” (ECP), which is defined as 340B eligible, the ACA requires “network adequacy’ of ECPs within a QHP. Insist on that if you’re having trouble obtaining a contract.
Next, you can provide leadership in your community to ensure that your patients are covered. Subsidies are available in the Marketplaces for as much as 94% of the premium cost. Below are a listing of tools and services that the Office of Rural Health Policy (ORHP) and HHS has made available to assist you in this effort. Please take advantage of these resources.
These are opportunities for your community to decrease its level of those uninsured. This could be an important population health activity for your community to consider, getting members of your community insured. There is a relationship between insurance coverage and health status. Perhaps, there could be nothing more important you, as providers, can do to increase the overall health of your population.