Diagnosis uncertain: Obamacare website retooled, but issues remain

HealthCare.gov retooled, but issues remain

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For as long as she can remember, Corissa Engle has had serious dental problems – ones that, in recent times, have become life-threatening.


The 31-year-old mother of three, who lives in Denbo, said last week she always tried to keep up on dental care when she was fully employed and had health care benefits.


But Engle, who recently lost her part-time job, also learned in October that she isn’t eligible to purchase health insurance under the Affordable Care Act, also known as Obamacare.


Her case exemplifies the variances that can occur in a federal program depending upon the state where it’s offered.


According to a screen shot from the HealthCare.gov website provided by Engle, the new federal health care law provides that she could be eligible for free or low-cost health care through Medicaid, but notes that Pennsylvania has chosen not to offer the new health care coverage at this time.


The site also informed Engle that she will not be required to pay a penalty for not having health insurance because of her income and because Pennsylvania declined to expand Medicaid to cover people in her situation.


Gov. Tom Corbett Friday announced a series of public meetings across the state required to make changes to the state’s current Medicaid procedures and said the commonwealth is formally beginning the process to obtain approval from the Obama administration to make needed changes in the Medicaid program. But any changes won’t be quick in coming.


“I don’t have the money to afford $20, $40 or $50 a month” for health care coverage, Engle said last week.


Engle, whose three children live most of the time with her husband, from whom she is separated, said she also sought help Nov. 14 from the state Department of Public Welfare. The department told her she wasn’t eligible for medical coverage because she isn’t on life-sustaining medicine.


But she is in an increasingly life-threatening risk from blood infection caused by her teeth.


On the day she talked with the welfare department, she went “to the only dentist that would see me without insurance and paid him $77 just for him to tell me I needed my teeth extracted and that he couldn’t do it.”


The dentist referred Engle to an oral surgeon whose next available appointment was Dec. 2. The surgeon informed the dentist that it would cost $185 per tooth and the money was due before the extraction.


The next day, Nov. 15, Engle went to the Mon Valley Hospital emergency room with chest pains, side pains and the right side of her face swollen so badly that her right eye was swollen shut.


She was transferred to UPMC’s emergency department in Pittsburgh, where a dentist surgically drained three abscesses and told her “it was crucial to save my life to have the teeth extracted as soon as possible and for the rest of my teeth to also be removed.


“The dentist told me that if I had waited much longer to get the abscesses drained, I would have ended up dead with either septic shock or a heart attack.”


She later found a dentist in Maryland who agreed to extract two teeth without insurance or prepayment, but said she knows that all of her teeth will need to be extracted.


While antibiotics she was given following the procedure have helped keep her infection at bay, Engle said it’s only a matter of time before her condition returns.


“My father had the same problem with his teeth, and had all of them extracted by the time he was 38 years old,” she said.


Young users essential

Engle was among Americans who were able to successfully log onto the official government website HealthCare.gov in October, just days before the government shutdown and just before it became obvious that the new website was riddled with flaws that prevented many from logging on or proceeding through the online application process.


On Nov. 29, Americans received their first look at a reworking of the troubled enrollment website HealthCare.gov. Bloomberg News reported Thursday that about 29,000 Americans had successfully completed applications on the site from Nov. 29 to Dec. 1.


The administration said traffic on the site exceeded 1 million users Dec. 2.


The Obama administration hopes to eventually enroll 7 million uninsured and underinsured people in 2014 under the Affordable Care Act. Many of the consumers are expected to qualify for subsidies.


The ACA aims to extend health insurance coverage to about 32 million uninsured Americans by expanding both private and public insurance.


But to work, the program must draw millions of young, healthy consumers who are needed in the new insurance exchanges to keep costs down.


But Bloomberg News Thursday reported the results of a survey by Harvard University’s Institute of Politics that found more than half of those 18 to 29 years old saying they disapprove of Obamacare and half expect it will increase their health care costs.


The survey of 2,089 Americans ages 18 to 29, taken Oct. 30 to Nov. 11, was taken before improvements were made to the federal website.


Treatment dynamic changing

Since President Barack Obama signed it into law, the Affordable Care Act has cost Washington Health System more than $2 million since 2010, said Gary Weinstein, president and chief executive officer.


“Probably the most significant effects have been around the way we get paid by Medicare,” he said. “We’ve seen a three-quarters-of-a-million-dollars per year reduction in the normal fee schedule payment updates.”


WHS, one of the largest employers in Washington County, has 40 sites there and in Greene County. Obamacare is a thorny challenge for the Washington-based system, but one it must take in stride, Weinstein said.


“It’s just something we know we have to live with,” he acknowledged. “We know the public sector and private sector know that health care costs are out of control and too high.


“And while we don’t necessarily like it, it is something we have to live with and we have to tailor our expectations on the amount of money coming into the hospital.


“We’re seeing the same kind of pressures on the private side (as) from the government,” Weinstein added. “Private employers also are concerned about health care costs and tell the government that something has to give.


“Our job is to provide the public with continuously improving quality health care and for less cost.”


One of his concerns is that because private-sector employers are increasingly offering high-deductible health plans with higher co-pays, some people may be reluctant to see a physician because of the cost.


“Patients have more skin in the game,” Weinstein said, “and are getting choosier about where and when they go. They will consider price and quality.


“It’s tough for (some doctors) to get patients to come into their office because they don’t want the co-pay. If you have congestive heart failure or diabetes, you really need to see your doctor on a regular basis.”


Weinstein’s concerns about higher co-pays and the changing landscape of health insurance were echoed last week by Congressman Tim Murphy, R-Upper St. Clair.


Murphy, who opposed the Affordable Care Act, had also expressed concerns about the security of the HealthCare.gov website when he talked with members of Washington City Council in September.


Murphy is chairman of oversight and investigation on the House Energy and Commerce Commitee and sits on the health and environment and economy subcommittees. He said during a phone interview last week that there continue to be problems with people who successfully log onto the website and submit an application to an insurer, stating that in many cases, insurance companies say they’re not receiving the information submitted to them and consumers aren’t always receiving confirmations from the insurers.


“The site still is not secure; data is still open for hackers to get names and Social Security numbers,” he said, adding that the website’s payment system remains to be certified.


While Murphy said he believes security and information flow problems can and will be fixed, he, like Weinstein, worries about the broad questions emerging about Obamacare’s impact on health insurance costs and what that means to consumers.


He mentioned several anecdotal stories about people who are making a choice about paying for a child’s education and forgoing health insurance, or some who work for large employers who have decided to drop spousal coverage.


He also predicted that health insurers will raise rates as a result of certain care mandates of Obamacare, noting that proponents of the plan had originally said American families would save up to $2,500 annually on their health care costs as a result of the ACA.


One last try

While the formal process to reform Pennsylvania’s Medicaid program and offer a private coverage option for the uninsured goes grinds through a series of public hearings and a 30-day comment period, Corissa Engle said she has made an application through the welfare department to receive assistance to take care of her dental problems.


But she understands the outcome may not be what she hopes for.


When she received the paperwork, she said the worker who helped her told her not to get her hopes up that the assistance would be approved.


“He said it was a long shot,” she said.


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