According to testimony in today's Senate HELP Committee hearing, as of last week, just three people have successfully enrolled through the federal health insurance exchange in the state of Alaska. Despite that and other stories of technical ineptness from across the country, CMS Administrator Tavenner told the committee that the Administration's target enrollment for the months of October and November is 800,000.
Does the ACA implementation "train wreck" (as predicted by Senate Finance Chairman Max Baucus (D-MT)) indicate a complete derailment or merely a scheduling delay? What are the concerns for rural patients and providers?
The next 30 days are critical. As both Republicans and Democrats pile on their complaints to the Administration, the computer glitches, access concerns and over-the-phone enrollment problems just keep building. If the system is not functioning fully in the very near future, it is almost inevitable that penalties of the individual mandate requirement will be postponed. A delay of the penalties innately causes a funding crisis for all of health care reform. A significant enough funding crisis could cause the legislation to implode under its own weight.
As many as 5 million rural patients are finding no relief in health care reform. According to the Flex Monitoring Team, Medicaid expansion, as called for when the law was passed in 2010, would have resulted in a 40% expansion of Medicaid enrollment in rural America. The Supreme Court, in June of 2012, put a wrench in that plan when it declared that states could opt out of Medicaid expansion, leaving millions who could have qualified for health coverage without an insurance card.
Millions more rural Americans will have difficulty finding affordable coverage because of the lack of market competition in certain states. For example, in Wyoming, two insurers are offering plans at prices that are higher
than in neighboring Montana, where a third carrier is seen as a factor
in keeping prices lower. In rural Baker County, Georgia, only one plan is available.
Finally, many rural providers may find themselves left out of health reform entirely. Rural providers must take care that they are "essential community providers" and ensure that their facility has a contract with the plans offered in their region. If they don't, many of their patients may be forced to travel to other providers to stay "in network" with their new insurance coverage.
As this train struggles to leave the station, it's disappointing that the President's legacy legislation, health care reform, was so poorly implemented. Rural America, which has higher percentages of uninsured and uninsured, needs and deserves some type of effective health reform. Time will tell if this train is temporarily off course or if it derails entirely.