HELENA — Health clinic director Kate McIvor says she and her counterparts across the state are excited about one of the biggest health care changes in decades: Tuesday’s roll-out of the new federal health insurance “marketplace” in Montana.
“We think it will mean more access to health care for more Montanans,” she said.
Yet McIvor acknowledges that her clinic in Helena — and just about everyone in the health and health insurance business — have a massive job ahead of them, getting consumers and themselves up to speed on how the marketplace will work to provide affordable coverage to Montana’s uninsured.
“I don’t think many people, myself included, understand it very well,” said McIvor, executive director of the Cooperative Health Clinic in Helena. “I’m glad that we’re going to get the education so that we can all talk to patients about what it is and what it means to them.
“My biggest concern is that people won’t take the initiative to sign up (for insurance). If people sign up, I think it will work.”
The marketplace, an Internet shopping center for health insurance policies, is a linchpin of the 2010 Affordable Care Act, the health reform law also known as “Obamacare.”
The law requires nearly all Americans to have or purchase health insurance by 2014, or pay a tax penalty.
Most Americans already have coverage through their job or a government program, such as Medicare.
Yet some 50 million Americans are without health coverage, including about 200,000 Montanans, and many more have bare-bones insurance that may not qualify as required coverage.
The marketplace is supposed to help close that gap, offering a one-stop shop for people to buy health coverage and, for many, to get a federal subsidy to help make that insurance affordable.
For low-income Montanans, the subsidies could reduce the cost of an individual health insurance policy to as little as $20 a month. For those higher up the income scale, however, the cost could be a lot higher — especially for older Montanans.
Every state has its own marketplace, and they’re scheduled to open for business Tuesday, at the web address of www.healthcare.gov. Three private insurers — Blue Cross and Blue Shield of Montana, PacificSource and the new Montana Health Co-op — will be offering policies on Montana’s marketplace.
While the Affordable Care Act has been in the news constantly, polls and anecdotal evidence indicate most citizens don’t know what the marketplace is, how to use it or what it offers.
To help bridge this knowledge gap, hospitals, health clinics, insurers, insurance agents, consultants, the state insurance commissioner and other organizations have embarked on a broad effort to help consumers become familiar with and use the marketplace.
“We’re doing whatever we can to get information out in waiting rooms, in emergency rooms, and wherever we come into contact with patients,” said John Flink, vice president of government affairs for MHA, which represents the state’s hospitals.
The three insurers selling polices in the marketplace have launched marketing campaigns, state Auditor and Insurance Commissioner Monica Lindeen has a website where her office answers consumer questions about the ACA launch, and hospitals big and small are training some employees to be expert “navigators,” or certified counselors who can help consumers understand the marketplace.
Julie Burton, a Billings Clinic spokeswoman, said health care providers are working together to point people to the marketplace as an option to get coverage, because they believe increased coverage means a healthier population.
“Evidence shows that people with health insurance are healthier than those without health insurance,” she said. “Those with health insurance are … less likely to develop complex chronic diseases and use the emergency (room) for nonemergency needs.”
A key part of the outreach will be the state’s federally funded health clinics, which serve mostly low-income Montanans, many of whom have no health insurance.
The clinics’ trade group, the Montana Primary Care Association, is training navigators who can help consumers with the marketplace. All 17 clinics, from Libby to Miles City, also received grants this year both to publicize the marketplace locally and train employees about it.
McIvor said her clinic will concentrate on informing lower-income families, who often are uninsured and stand to benefit the most from the marketplace and its subsidies.
The Helena Cooperative Health Center served 7,000 people last year, and half of them had no insurance.
Low-income clients pay reduced prices at the center, but if they need hospital or specialized care, they usually can’t afford it, McIvor said.
If those clients can get affordable health insurance through the marketplace, they might be able to get that specialized care — as well as more frequent primary care at the clinic, she said.
“The mission of (the clinic) is to provide health care to everyone, regardless of their ability to pay,” McIvor said. “We’ve been doing that on a shoestring for years.
“We’re hoping for our own sake and our patients’ sake that we can start bringing in more revenue and serving more people, and that we can refer (patients) to a higher level … and, with health insurance, they’ll be able to afford that care.”
The Helena clinic also received a $5 million grant from the ACA to expand its services. Construction is starting this year to add another dentist, more medical exam rooms and additional counselors.
McIvor said that if more patients are insured, the center can expand staff and serve more people.
If the ACA does lead to more people with health insurance, there will be more demand for primary health care, as provided at the federally funded clinics, other clinics and physicians’ offices across the state.
Tom Roberts, a physician who heads the Western Montana Clinic in Missoula, said that potential increase in demand remains an unknown, but he thinks primary care professionals in Montana can handle it.
“We think we have enough slack in our practices (at the clinic) that we could pick up another 10 to 15 percent of patients without too much trouble,” he said. “I don’t see it as an issue.”
The big question remains, however: Will enough of the uninsured actually buy policies on the marketplace to make a dent in their numbers? Will they have the desire — and the money — to buy these policies?
John Doran, director of strategic marketing services for Blue Cross and Blue Shield of Montana, said it’s hard to forecast what will happen, and that no one truly knows how this new world will unfold.
“We’ve been working on our strategy for a long time, and we’ll carry it out,” he said. “But like most insurers, we’ll have to be flexible. … Our ultimate goal is to reduce the number of Montanans who don’t have health insurance today.”