How Parlkand Helps the Chronically Ill, Low Income Folks of Dallas Get the Care They Need with ACA

By now, most folks have heard about the copper plated ACA insurance plans, the ones with the $5000 deductible and low availability of providers. Some people with chronic diseases like copd, dm, cad have signed up for this coverage because the premiums are so low--they can not afford to move up to silver or gold--even though they can not afford to use this new insurance.

http://money.cnn.com/2015/02/12/news/economy/obamacare-costs/?iid=EL

Have these folks withered away due to lack of access to their insulin, heart specialists and inhalers. Not in Dallas County, thanks to Parkland, the so called "charity" health care system.

Insurance companies are usually pretty good at guessing how much they will have to pay out in care costs for their enrollees. However, ACA was a new type of insurance. Folks with massive medical illnesses like congestive heart failure now qualified for the same plans that healthy people bought. Luckily for the privates, most people with truly devastating illness are on Medicare or Medicaid, However, there are some middle aged people who are quite ill who do not qualify for either, because they are not old enough and not poor enough. These are the folks who benefit most from ACA--and they are the biggest risk for the privates that participate in ACA. The high deductibles, coypayments and limited provider lists were supposed to cut down on insurance utilization.

Despite these measures, insurers under the ACA in Texas are asking for double digit premium increases next year, citing higher than expected utilization of insurance.

http://money.cnn.com/2015/06/02/news/economy/obamacare-rates/

High utilization? Really? How can folks with no money afford these high deductibles and copyaments? How can they find providers?

One way is by getting their health care at places like Parkland in Dallas. Two years ago, some public hospitals attempted to pay their patient's premiums in order to get them enrolled in private insurers which would then reimburse the public for so called charity care. As best I can tell, attempts to pay patient's premiums were thwarted. However, the public hospitals have a new way to help you get more out of your copper insurance plan. Parkland's solution---waive the high deductibles and copayments that are intended to keep patients from seeing doctors except in dire emergencies.

http://www.dallasnews.com/news/local-news/20150213-parkland-memorial-hospital-to-give-insured-low-income-patients-a-break.ece

This is a great deal for someone who has to buy ACA insurance because their income is just barely high enough to qualify but who can not afford a policy that really meets his or her health care needs. And, it allows a public funded hospital district to recoup some of its losses from Texas' decision not to expand Medicaid. However...

When a public hospital and clinic makes it easier for people to bypass the deductibles and copayments which were intended to discourage use of the insurance (and insurance company bills) this is turn leads to higher than anticipated spending by the insurers---and rate increases.

While some may call the rate increases unfair, remember that all urban residents pay for the unfunded care which their counties offer. There is no "free" care for anyone. We either pay more in property taxes or we pay higher insurance premiums. The important thing is that people with chronic diseases like cancer get the care they need.

Of course, in a "perfect" state, Medicaid would have been expanded, the feds would have stepped in to pay for the care of the low income, chronically ill uninsured people whom public hospitals have been treating with funds provided by local taxpayers. This would allow the privates who participate in ACA to focus on the not so chronically ill people who are not guaranteed to generate tens of thousands of dollars of medical bills each year.

So, if you do not like the sticker shock of your health insurance rate increase in Texas, maybe you should apply a little pressure in Austin to accept the Medicaid expansion. Texas cities are not sitting on limitless sources of wealth. They can not afford to pay all the health care costs of all their (older, sicker, poorer) residents. And right now, they are not paying all the costs. Folks with ACA insurance are helping them.

If you know anyone who rejects the Medicaid expansion because they do not want to be forced to pay for the health care of strangers, you might want to remind them that they are already paying. The Medicaid expansion will just make that funding more equitable.