WHAT TO EXPECT
Newly insured through Obamacare? Considering it? A few things to remember: There is no such thing as an "Obamacare" card. The insurance cards that come with plans bought through the exchanges will not look like Medicare cards, but like regular private insurance cards -- with a BlueCross BlueShield, Cigna or United logo. "If you are in Network S, you are in Network S, whether you purchased your plan through the exchange or have it through your employer," said BlueCross BlueShield of Tennessee spokesman Gary Tanner. The traditional insurance billing process will apply based on deductibles and co-pays.
Some plans bought on the exchange may have a narrower network. BlueCross' Network E plan, for example, has lower premiums, but is only offered in larger metropolitan areas and -- in Chattanooga -- is limited to Erlanger Health System as the provider. Erlanger officials say they are expanding their network of physicians. "That includes the addition of primary care physicians that will help to assure access for the newly insured," said Joe Winick, senior vice president at Erlanger.
Missed the Dec. 24 deadline for Jan. 1 coverage? Open enrollment lasts until March 31.
There is about to be a scene change in the drama surrounding the unfolding of the Affordable Care Act: Off the website and into the doctor's office.
The countdown to 2014 is especially meaningful for those who were able to become insured under the health reform law and can finally start seeing their coverage kick in Wednesday.
And it is significant for the doctors and hospitals that are watching closely to see what effect the law will have on their patient base.
Approximately 4,500 Tennesseans and 6,850 Georgians had enrolled on the health insurance exchanges as of Nov. 30, according to the U.S. Department of Health and Human Services.
Those numbers are expected to swell as the deadline for Jan. 1 coverage won several federal extensions made as a result of the HealthCare.gov site's botched launch.
The series of extensions kept brokers and insurers cranking through the holiday week to set up policies and mail cards and information packets to new enrollees.
"Our volume did increase as the deadline for the January coverage approached, with multiple thousands calling every day," said Gary Tanner, spokesman for BlueCross BlueShield of Tennessee, the state's largest insurer.
The company has not yet released its total number of enrollees.
At American Exchange, a growing Chattanooga-based broker service that specializes in the new marketplace, the call volume quadrupled in the last few days before Christmas Eve.
"We saw most of our volume come in December, and especially in the last two weeks," said Vice President David Yoder. "This month, we have people who are saying, 'I need services, and I need them sooner [rather] than later.'"
A key goal of the Affordable Care Act is to improve access to primary care, in the hope that fewer uninsured patients will end up with critical conditions that could have been prevented if detected and treated sooner.
"Many of the uninsured are already accessing health care somewhere; it's just the wrong place and the wrong time -- like the emergency room," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians and a family physician in Kingsport, Tenn. "We are hoping we can catch illnesses at our offices before they reach the point where it becomes devastating for their health and their finances."
Preventive care is one of the essential health benefits that all insurance plans must now provide, prompting some concern that new patient volume could overburden primary care offices similar to what happened in Massachusetts in 2006, when the state's mandated health insurance law went into effect.
Wait times to get an appointment at primary care physicians' offices grew significantly, and they have remained high, according to the Massachusetts Medical Society. Many offices have refused new patients.
Blackwelder said his organization does expect a shift, but he does not anticipate a widespread bottleneck effect at primary care offices in the coming months.
A survey by the organization found that three-fourths of its members still have same-day appointments available, and 40 percent have extended hours.
"We don't have that anxiety that we will all be in the same situation Massachusetts found themselves in," said Blackwelder.
But he did acknowledge that availability could vary according to patient-physician ratios. In some regions, especially rural areas, there may be more of a strain on the smaller number of primary care doctors practicing there.
He said doctors would need to adopt more creative forms of caring for patients, including electronic health record-keeping systems and even telemedicine, where information is exchanged by phone or online.
Dr. Stephen Adams, a professor of family medicine at the University of Tennessee College of Medicine Chattanooga, said he doesn't anticipate any local problems with patient access to primary care in the coming months.
The main reason, he says, is that health care costs only keep rising.
"I personally have not met one person yet who's been able to register for insurance through the exchanges, but have heard from many patients that they are losing access due to the increasing cost of insurance," he said. "Additionally, copays are going steadily up and covered benefits are dropping, and I see patients skipping needed medications and follow-up visits due to economic difficulties."
Whether there is a steep uptick in the number of primary-care patients because of health reform, there is still widespread concern about a looming primary-care physician shortage.
The shortage was a concern long before Obamacare, said Blackwelder. An aging population and a declining number of medical school students choosing the field are key factors in the problem.
But the growing number of insured patients only underscores the need for more advocacy to address the shortage through incentives and narrowing the salary gap between family practitioners and specialists.
"There are two main things that improve health outcomes: Having insurance coverage, and having a routine source of comprehensive care," said Blackwelder. "The insurance side is being addressed, but we need to do more to address the primary-care side."
Most of those enrolling through BlueCross the past three months have previously been insured, Tanner said. But the company has seen a mixture of insurance backgrounds, including those purchasing insurance for the first time.
About 40 percent of those coming through American Exchange have been uninsured within the past year, Yoder said.
Many people Yoder works with have been declined coverage in the past, or paid sky-high premiums. Whenever these people finish the enrollment process, they celebrate, he said.
"This is the best part of my job," Yoder said. "I've never had a job that when you sell people something, they are so happy and relieved. I feel like I'm working at Apple when they're selling their new iPhone."
One of those relieved clients is Kathy Harvey, 56, who works at National Brands Liquidation and Carr Surplus -- a small local company her husband co-owns.
Because she has epilepsy, Harvey has always been unable to get insurance, except through a state program for those with pre-existing conditions, which is ending this year.
The company, which has six employees, does not offer insurance because premiums have been unaffordable.
But after working with American Exchange, the company has helped enroll all of its employees through individual plans both on and off the Obamacare exchanges.
Each employee's insurance plan is different. Some will pay slightly more than they currently do for individual plans, and others will pay less.
Some are being insured for the first time, like one employee who could not get coverage because of a serious pre-existing condition. His costs, Harvey said, will be "unbelievably low."
To supplement employees' coverage, the company is using a new American Exchange product called the Personal Health Account, recently launched with Chattanooga prepaid card firm TransCard and MasterCard.
The account is similar to a health savings account, but employer contributions to the account can be used to pay for premiums along with copays and deductibles.
To use the account, employees will have a MasterCard that can only be furnished at health care providers.
Harvey did not enroll through the Obamacare exchanges because she was not eligible for subsidies and the price was higher than she wanted to pay.
But the health reform law did mean that she could enroll in a Humana plan she previously would not have qualified for. Under her new plan, Harvey is paying about $400 less than what she was previously.
"We were afraid of the Affordable Care Act because we couldn't pin it down for our company," she said. "But everyone here is thrilled with how it is looking for us."
Harvey and her husband have already scheduled their appointments with their doctors for next year.
Contact staff writer Kate Harrison at kharrison @timesfreepress.com or 423-757-6673.
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