Athens’ medical discount plan in limbo

John Boyle, a 63-year-old Athens guitarist, has never bought health insurance. He credits good genes and good luck with keeping him healthy enough not to need it.

But now, a couple of years before he becomes eligible for Medicare, he is looking for a little extra health security.

“As I get older, I hope I can stay healthy,” he said. “It is a concern.”

[youtube][/youtube]Last year, a program designed with people like Boyle in mind was in the works in the Athens area. But now the organizers have put the plan on hold because they’re worried that it could actually discourage people from obtaining insurance under the Affordable Care Act.

(The ACA enrollment deadline for 2014 is Monday. That remains in effect, though the government said last week that people who have attempted the enrollment process and not been able to complete it will be allowed extra time, till about mid-April.)

Interesting idea, but awkward timing

The Athens Health Network is a coalition of health providers created to combine existing resources, such as clinics and hospitals, into a seamless whole to make inexpensive care available to uninsured or underinsured people.

The network’s Health Assurance Program was intended to work roughly like a warehouse club, which allows dues-paying member to buy discounted products. Members of the health program would pay a monthly fee that entitled them to purchase discounted care from doctors, hospitals and other health providers who had agreed to be part of the system. The program was modeled on a nearly 8-year-old network that first proved successful in Reno, Nev., then spread throughout the rest of that state.

Boyle contacted the Athens Health Network as soon as he read about the proposed program in local Athens newspapers. (GHN produced a series of articles on the idea.)

The musician, who is unemployed, has not tried to purchase insurance through the health insurance exchange created by the ACA. He said he doesn’t make enough money to qualify for a subsidy on the exchange and cannot afford insurance otherwise.

If Georgia had expanded Medicaid coverage to include people earning up to 138 percent of the federal poverty level, as the ACA encourages states to do, Boyle would have qualified for Medicaid. But Georgia, like a number of other states, has decided against expansion. Gov. Nathan Deal says the cost to the state would be too great.

As a result, Boyle said,  “I’m one of the people who slipped through the cracks.”

This month, Boyle received a call from Laura Alexander, the new director of Athens Health Network, informing him that the health assurance program would not be moving forward.

Efforts in conflict

Given the rollout of the health insurance exchange and widespread uncertainty about its success, Athens Health Network is halting the discount program.

When Alexander became director of Athens Health Network in October, her top priority was talking to health care providers and designing a fee structure for the medical discount program. But the doctors and hospital officials she talked with were worried: Why should they offer discount services to people who could have signed up for insurance through the ACA exchange?

“We kept hearing that we were describing a program that was in competition with the Affordable Care Act,” Alexander said.

Obviously that was a problem, because the organization wants more people signed up for health insurance.

It was also clear that as more people signed up for health insurance, fewer would need the medical discount plan. And that could make the original plan unsustainable.

To cover the costs of the program, there needed to be a sizable population paying monthly fees, said Tracy Thompson. She is board chairwoman for Athens Health Network and executive director of Mercy Health Clinic, one of the three Athens clinics that provide free or low-cost services for uninsured people.

Adjustments all around

Out in Reno, the program that sparked the Athens Health Network’s interest has also made big changes following the rollout of the federal health care law. Nevada is one of the states that gave the OK to Medicaid expansion, and that led some of the lowest-income members of the discount network to drop out and enroll in Medicaid instead.

Nevada’s Access to Healthcare Network also partnered with a company to provide health insurance to its clients through the state’s insurance marketplace. (Nevada runs its own exchange, or marketplace, under the ACA. Georgia is one of numerous states where the exchange is federally run.)

“We saw what was happening and we adjusted,” said Niki King, chief operating officer of the Reno-based organization.

Athens Health Network, which was still in the planning stages for its program, did not have existing staff or infrastructure to make such a switch.

Concept is not dead

With the discount program on hold, the Athens nonprofit is watching to see how implementation of the ACA will change health care for low-income people in the area.

“There are lots of gaps,” Thompson said. “We’re just going to identify those gaps and fill in where needed.”

In the coming months, Athens Health Network will try to determine how many low-income people, like Boyle, remain uninsured after the ACA takes effect. With no Medicaid expansion in Georgia, the number of such people statewide is likely to be in the hundreds of thousands.

That being the case, the medical discount plan may not be derailed for good.

“If, in a year, we have found out the Affordable Care Act has failed to ensure access to a significant number of uninsured people in Athens,” Alexander said, “we can always pull . . .  [the discount program] back off the shelf.”

Aaron Hale is a former government and public safety reporter. He currently is a first-year graduate student in the health and medical journalism program at the University of Georgia.