Staff Photo by Laura-Chase McGehee/Chattanooga Times Free Press Mother Kristin Ford kisses her 6-month-old son Wilder Ford at his six-month checkup with Dr. Peter Rawlings. Ford thinks Rawlings is"wonderful!" "He answers all my questions and is very reassuring," she said.
Nearly every day, family medicine specialist Dr. Chip Harris sees patients who delay recommended preventive care because of money.
Usually it’s the “big-ticket items” such as colonoscopies that get put off, said the Erlanger South Family Medicine Practice doctor. Those colon cancer screenings cost about $1,000, so a 20 percent co-payment would cost a privately insured patient $200 out of pocket — and that’s if they’ve already met their deductible requirement, he said.
“The biggest barrier that we see to preventive care is the cost,” he said. “You kind of beg, borrow and steal and figure out how to get those services done.”
But under new federal mandates, cost should no longer be a barrier to getting recommended shots, screenings or checkups for those with insurance.
Under the health care reform law passed by Congress in March, health insurance plans that begin on or after Sept. 23 must cover recommended preventive services and may no longer charge patients copayments or deductibles for these services when delivered by an in-network provider.
Starting in January, Medicare enrollees will get certain free preventive services, including annual wellness visits and personalized prevention plans.
Health officials say the expanded coverage is critical. Americans get preventive care such as cancer screenings and routine vaccinations at about half the recommended rate, mainly for financial reasons, according to the U.S. Department of Health and Human Services.
Staff Photo by Laura-Chase McGehee/Chattanooga Times Free Press Dr. Chip Harris uses humorous theatrics to teach his patient, 9-year-old Alicia Moree, how to properly use her nasal spray at Erlanger South Family Medicine Practice. Alicia found Dr. Harris "nice and very funny."
About 70 percent of American deaths are attributed to chronic conditions that, in some cases, could be prevented, including heart disease and cancer, according to HealthCare.gov. Chronic diseases also account for 75 percent of U.S. health care expenditures.
Next year, 31 million Americans who will enroll in new employer-sponsored health plans, and 10 million people in new individual plans, will get the benefit of the new mandates, the White House says.
“We are shifting from health insurance coverage, meaning coverage for sickness, to ... coverage to keep you well,” said Nancy-Ann DeParle, director of the White House Office of Health Reform, when announcing the new regulations last month.
Children will get annual “well-child” checkups for free and recommended immunizations under the new rules.
Chattanooga pediatrician Dr. Peter Rawlings said that’s going to make a noticeable difference. He sees patients who can’t afford to pay for both in-office visits and vaccines for their children, so they plan to get the shots at the public health department at cheaper rates.
“Making two different visits is kind of awkward for some parents,” he said. “You find some of these kids get behind on their shots.”
He said he hopes insurance companies will adopt the new regulations without a hitch.
“The question is, is somebody going to find a loophole?” he said.
IMPACT ON INSURERS
BlueCross BlueShield of Tennessee expects a “minimal” impact, although the insurer still is evaluating what exactly will be covered for free under the new mandates, said Lynda Johnson, director of the office of health care reform within BlueCross.
“Most of the things we already covered,” she said.
It’s known, though, that annual checkups that used to be subject to a $20 or $30 copay now will be free, and colonoscopies, previously subject to copays and deductibles, also will be free, Johnson said.
At Cigna Healthcare, more than 75 percent of group plans already cover 100 percent of preventive benefits, spokeswoman Judy Hartling said in an e-mail.
“Compliance with the new regulations will be easy for us,” Hartling said.
Cigna supports the shift from focusing on illness and injury to preventive care and improved health, she said.
Some health care experts object to the inclusion of behavior modification services, such as smoking cessation, weight loss and alcohol treatment programs, in the coverage requirements.
The nonprofit Foundation for Health Coverage Education, which aims to connect the uninsured to public and private insurance options, argues that those services can be costly and won’t necessarily save much money.
“We believe it’s not effective and will increase premium costs dramatically,” Executive Director Philip Lebher said. “You can’t legislate personal responsibility and self-discipline.”
BlueCross officials agreed that behavior modification programs such as tobacco cessation have less proven effectiveness than other preventive services, such as mammography and colonoscopy.
The long-term impact of the change on the overall population remains to be seen, said Dr. Richard Cassidy, BlueCross chief medical officer.
“Anything that lowers the barriers to access to care is a positive thing,” he said. But there are many factors that contribute to poor health, he said.
“Do I believe that taking a preventive visit from $20 to zero is going to have some huge population impact? I think it’s hard to say,” he said.
There’s no doubt that costs will go up, at least in the short term, Cassidy said.
“You’re in theory doing the right thing and it should lower costs over time,” he said.
But at least initially, more screening done means more potential treatments and more spending, he said.
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Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...