The Arizona Daily Star spoke with Pima County Medical Society president Dr. Charles Katzenberg about local effects of the Affordable Care Act, which will start enrolling people in federally subsidized health insurance Oct. 1. The enrollment period goes until March 31.
Anyone who enrolls before Dec. 15 will have insurance starting Jan. 1.
Local effects of the Affordable Care Act include an expansion of the state’s Medicaid program that is expected to add more than 300,000 people to the government insurance program for low-income people.
The following are excerpts from the Star’s interview with Katzenberg, a Tucson cardiologist:
Does the Pima County Medical Society play a role in educating patients about the Affordable Care Act?
Our focus is providers, in their offices. We have meetings set up for physicians and their office staff and the speaker is Dr. Betsy Thompson, who is the chief medical officer for Region Nine of the U.S. Centers for Medicare & Medicaid Services. (Region Nine includes Arizona, California, Hawaii and Nevada.)
What kind of a role will local providers have?
We’d like to have providers in their offices have resources for people to access the system. I have three focal points we’ll try to get out:
1. The health insurance marketplace phone number, 1-800-318-2596.
2. The government has a pretty good website: www.healthcare.gov
3. Arizona AHCCCS: www.azahcccs.gov/
(AHCCCS stands for the Arizona Health Care Cost Containment System, which is Arizona’s Medicaid program.)
There are two separate things going on in Arizona. One is with the federal government; the other is Medicaid expansion through the state. Hopefully it will be set up so anyone going to the marketplace will be directed to the right place, including Medicaid.
Do you think the new law will have an immediate impact in Pima County?
It will have a huge impact. Medicaid expansion and the health marketplace as of Jan. 1, 2014, are going to make health care accessible and more affordable. So, yes, I think there will be immediate impact.
What kind of changes are providers expecting?
For most of us who are doing day-to-day health care, the whole process is still a little bit under the radar.
Are there enough primary-care providers in Pima County to handle an anticipated increase in patients with health insurance?
The biggest challenge is dealing with the number of people who are going to want providers, particularly primary care.
If you do the math, Pima County probably does not have enough capacity if everyone with eligibility walked into the office on Jan. 1. But that won’t happen. It will be a trickle.
How do you see the landscape of health care changing in Pima County over the next few years as the Affordable Care Act’s provisions are adopted?
I think there will be more nurse practitioners and more physician assistants on the front line and teaming up with physicians as practice teams.
We’re not training physicians very quickly or in great numbers. The country has a doctor shortage...If everything works, what we’d hope to see is less emergency room traffic.
Urgent care businesses are seeing progressively more traffic in Tucson. That is keeping them out of the ER, but it fragments the attempt to have a patient-centered medical home.
Everyone should have a primary care physician as a kind of source of health care...We’ll see an increase in patient-centered medical homes where people can have more comprehensive and coordinated care.
One of the changes that will begin in January is an expansion of the state’s Medicaid program. Is that a good thing for the local health care system or will it just run up costs?
Yes, it is a good thing. With Medicaid expansion we are taking our tax dollars and investing in them locally. It gives people access to care. It gives the caregivers, the hospitals, the physicians, compensation for their work. It is going to create jobs. My bottom line is always that it’s the right thing to do.
What about Medicare patients?
For most Medicare patients nothing will change. In fact, in many ways there are parts of the Affordable Care Act that will be beneficial to them.
For instance, they’ll get preventive visits and testing without co-pays. They are going to have the doughnut hole for drug costs eventually close.
The other thing is, there’s all this talk about the Affordable Care Act negatively impacting physicians. There’s nothing in the ACA that says anything about physician compensation.
The cuts to Medicare that people are talking about are cuts to private insurers who offer Medicare products.
The reason for those cuts is the private insurers were paid more tax dollars than it costs to take care of the patients. So those are the cuts people are talking about. It’s a little complicated.
Somewhere between 92 and 94 percent of doctors in the country take Medicare. There’s no reason to think that’s not true locally.
Do you think there is enough awareness of the ACA among the general public?
Absolutely not. There is a huge challenge to educate not just the public, but physicians, hospitals and providers.
Anything else you’d like to say about the ACA?
To me the ACA is a step in the right direction. But it really doesn’t get us as far as I’d like to see. We are still going to have 20 to 30 million uninsured (nationwide).
The elephant in the room with the ACA is the costs of health care are not directly addressed. The cost of health care is still going to be a huge issue.
My biggest disappointment is the lack of success in educating the public and physicians...hopefully we’ll see that pick up.