VOL. 128 | NO. 201 | Tuesday, October 15, 2013

The Oct. 1 start of enrollment in health care exchanges may be the most visible part of the Affordable Care Act so far.

But changes to insurance and health care nationally already are about something other than lowering health care costs or widening access to health care and health insurance coverage.

I think for most people, they assumed that this was all about providing care for the poor, said Church Health Center founder Dr. Scott Morris on the WKNO-TV show Behind The Headlines. What I think people will find jaw-droppingly unbelievable is that at the Church Health Center, which sees effectively 100 percent of our patients working and uninsured, 80 to 90 percent of our patients it will have no impact on whatsoever.

Thats because so far, the impact is on health care exchanges and doesnt involve a Medicaid expansion.

Tennessee Gov. Bill Haslam initially said no to the expansion, which would be funded fully by the federal government for the first three years and then be 90 percent federally funded for three years after that. Haslam has been negotiating terms for an expansion since initially turning it down.

So health care exchanges whether federal or state apply to those who are at least 138 percent above the federal poverty index.

If youre a single individual and you make less than $16,000 a year, or you are a family of four and your income is less than $32,000 a year, when you go to the exchanges and you pop in your data, what will come back is that you will get nothing. The poorest people get nothing, Morris said. The assumption was absolutely that every state would expand Medicaid. So if you are working in a near-minimum-wage job, youre going to have to pay full bore, same as you would today, for health insurance. And they just cant afford it.

Dr. Richard Thomas, a consultant to several local hospitals, estimated 25,000 to 30,000 Memphians without health insurance could be covered through the exchange. And he added that if the state had taken the Medicaid expansion, the uninsured with access could have increased by another 80,000.

Thomas said the Affordable Care Act has made some difference with adult children remaining on their parents insurance and payments of several hundred dollars each to consumers from insurance companies who in the past did not allocate 80 percent of the premiums paid them to health care costs.

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Local Health Care Changes Limited So Far, Doctors Say