Coverage began Jan. 1 for the federally managed insurance exchange in Alabama, part of the federal 2010 Affordable Care Act, offering health care coverage to many who previously could not afford it. While local hospitals and other health care providers say they have prepared for an influx of patients, some are unsure what that increase might be, while others believe any expansion will be minimal for the foreseeable future.
"We really don't have a good estimate on how we'll be impacted," said Bryan McCauley, CEO of Stringfellow Memorial Hospital in Anniston. "It's going to be driven in large part by the patients signed up locally and we would need to know what that impact is locally."
Detailed federal statistics on the number of Americans with coverage through the insurance exchanges are not yet available.
McCauley said, however, that Stringfellow was prepared for an influx in patients, whether that be from inpatients or in the hospital's emergency room.
"I know we've got the capacity in our ER to accommodate an increase," McCauley said. "We are ready to hire more staff."
Stringfellow averages 24,000 emergency room visits each year, McCauley said.
Ameila Wofford, planning and development officer for Quality of Life Health Services, which operates several community health care centers including one in Anniston, said administrators there don't expect a huge influx in patients, maybe a 10 percent increase in the coming year.
"Half of our patients coming in now already don't have any kind of insurance," Wofford said.
Wofford added that it is hard to project what the full impact of the exchanges might be because enrollment in them got off to a slow start. Enrollment for the exchanges began Oct. 1. However, technical glitches with the website set up for enrollment bogged down the process until the government upgraded the site in December.
Rosemary Blackmon, vice president of the Alabama Hospital Association, agreed with Wofford, saying many hospitals in the state are having trouble projecting how the exchanges might impact them.
"It's a big question mark for most people at this point," Blackmon said. "Since there was such a slow start to enrollment, it's really hard to know how many more patients there will be."
David McCormack, CEO of Regional Medical Center in Anniston, said his staff expect no significant increase in patient loads from the exchanges for the foreseeable future. RMC provides millions of dollars in uncompensated care every year to uninsured patients through its emergency room. McCormack said if any of those residents were to get insured through the exchange, they will likely still just come to the hospital's emergency room, meaning a net gain in patient visits.
"It's easier to get to the ER ... a lot of times if you go to a doctor's office you have to pay up front and there can be a long wait," McCormack said.
McCormack said RMC’s emergency room averages about 45,000 patient visits each year. He noted that even if there is an uptick in patient visits to the emergency room, it could handle the extra load. Since October, RMC has made changes to its emergency room operations, resulting in shorter wait times for patients, McCormack said.
McCormack said if there is any huge increase in patients, it will come from Medicaid expansion. Through the ACA, the federal government is offering states three years’ worth of money to expand their Medicaid programs to cover more low-income Americans. Alabama, however, has so far chosen not to expand Medicaid but instead reform its program.
McCormack said he supported Medicaid expansion.
"It's not just good for health care, it's good for the whole state," McCormack said.
Blackmon said without Medicaid expansion, hospitals in the state will be burdened with extra costs. To afford the Medicaid expansion, the federal government is cutting funding for uncompensated care.
"We're hopeful we can still come up with some sort of Alabama solution," Blackmon said.
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.