WJTV News Channel 12 - How does the Affordable Care Act affect you?

How does the Affordable Care Act affect you?

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The Affordable Care Act is changing the way health care works in the country. It's also affecting individuals and providers.

"We cannot do things the same way we have been doing things in the past," said David Hughes, the Chief Financial Officer for Vidant Health.

Hughes says the new health law is putting strains on hospitals.

"Vidant Health currently is absorbing about, in this current fiscal year, about a 20 million dollar payment reduction beyond what it had the year before," Hughes said.

Providers say they're areas of the law that concern them.

One of those is the change in definition between an inpatient and an outpatient. Before the law, providers determined the classification based on the severity of the patient.

But now, there is a two-midnight policy, a rule that began with Medicaid, but now applies to everyone. For a patient to be considered an inpatient, they have to be in the hospital for at least two midnights.

This move is costing hospitals millions of dollars every year.

"About 50 patients a day who would have been classified as inpatient to an outpatient setting," Hughes said. "That's reduced our payment anywhere from $750 to $1,000 per encounter."

With more outpatients, hospitals are now called upon to ensure the patient is doing everything the doctor told them to.

"It appears that our society at this date and time is expecting the hospital setting to be more of our brothers keeper," said Ed Piper, the President and CEO of Onslow Memorial Hospital.

Piper said asking hospitals to try to change people's behavior is a tall task, and one that may not be feasible.

"I think theoretically it looks good, but practically it won't work," Piper said.

The Affordable Care Act also aims to change health care to be a more preventative system, where individuals are seen by primary care doctors more often to reduce the dependency on expensive hospital visits.

Al Delia, the Director of the Office of Health Access at the Brody School of Medicine, says all of these changes are creating confusion.

"I think a lot of the confusion is actually lack of knowledge," Delia said.

He says many people now have insurance for the first time, and may not know how to use it.

Eastern Carolina residents have 13 different plans to choose from. He tries to educate them about their options.

"Which insurance policy is the right one for me? That's going to be a family by family, individual by individual choice in terms of what their health is like. What their finances are like. The level of risk they want to take," Delia said.

For people like Lorenzo Hernandez, they're happy to have this affordable option.

"If I didn't have this help from the government, it would be about close to $600 a month, and this is a great help," Lorenzo said.

For others, they're concerned about the price.

"They call it the affordable care act, but I don't find it to be very affordable," said Kathleen Forrest.

Delia says some people are now being told they can't see their normal doctor, a decision he said is made by insurance companies during their discussions with different doctors and hospitals.

Overall, he is very happy with the new health law because it offers more people affordable options, and ensures people can't be dropped for pre-existing conditions.

"I think those are all good things, and that's part of what the affordable care act is all about," Delia said.
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