By THANH TAN
A program created to help insurance-seekers in Texas cut through the complexities of federal health care reforms is shutting down in April, just 15 months after it opened its call center and years before the law goes into full effect.
Officials with the Texas Department of Insurance say they plan to help
fill the gap, but it is unclear whether they can handle what some health
experts call a beast of a policy change: millions of new patients will
be required to acquire health insurance, and those first-time policy holders will need help understanding their rights and benefits.
When President Obama signed the Patient Protection and Affordable Care Act
in 2010, a consumer education program was also created. That September,
the federal government awarded the Texas Department of Insurance a $2.8
million grant to start the Consumer Health Assistance Program.
As of January, the department reported, the program had answered 8,900
calls and resolved nearly 5,600 cases statewide. A staff of nine
employees had dispersed multilingual public service announcements, given
field presentations, begun a Web site and staffed a hot line.
State officials say they were allowed to use unspent money to keep those
employees on through April 14. But federal financing was not renewed,
and unlike some other states, Texas is not seeking alternative means to
maintain its program.
Medical officials who are aware of the unit’s work lament the timing of
its closure, as the Affordable Care Act’s rules will not be completely
in place until 2018.
In the meantime, health providers are anticipating a nightmare
situation. Nearly a quarter of Texas’ population is estimated to be
uninsured. Unless the United States Supreme Court dismantles parts or
all of the law, those people will be required to sign up for benefits
beginning in 2014.
“There will be lots of people who’ve had no experience with insurance
before who will need to have a lot of guidance,” said Regina Rogoff, the
chief executive of People’s Community Clinic in Austin, a safety net
provider. “They’re driving blind.”
Louis J. Goodman, the chief executive of the Texas Medical Association,
said doctors were as perplexed as consumers. The federal law is wide in
scope, and the association has poured resources into helping
practitioners understand the rules and deadlines.
“We’ve worked on the doctors’ side as much as we can,” Mr. Goodman said,
but more consumer education is “absolutely necessary.”
In the field, he said, overhead costs at clinics could rise because
patients increasingly rely on nonmedical staff in their doctor’s office
to explain benefits.
Processing claims can be tedious. The medical association’s Hassle
Factor Log, a last resort for doctors trying to resolve claims issues,
recovered a record $1.6 million last year for 300 doctors who would have
otherwise gone unpaid for their services.
Genevieve Davis, the medical association’s payment advocacy director,
said she regularly spoke with doctors who complain of spending less time
with patients and more time mired in paperwork. And when insurers or
employers refuse to cover a service, patients blame their doctors.
“Trying to get patients to understand that takes away from being able to focus on practicing medicine,” Ms. Davis said.
Health providers say that what separates the assistance program from
other insurance resources is that it arms consumers with information on
the new health care laws before they walk into a doctor’s office.
But John Greeley, a Texas Department of Insurance spokesman, said the
tools developed by the program would carry over to a different section
in the agency that covers general consumer concerns. He said the
department would maintain resources to help people gain access to
insurance.
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