Why public hospitals are selling Obamacare policies

Providers hope wider customer base can help revamp their image

Public health systems serving disproportionately high numbers of low-income patients are selling plans on the Affordable Care Act's (ACA) insurance exchanges that aim to widen their customer base, the New York Times' Anemona Hartocollis reports.

In New York City, the Health and Hospitals Corporation (HHC) has created MetroPlus, which sells plans on the state exchange and looks like any other insurance option. The public hospital agency sees the plan as an opportunity to add stable, insured patients to a system that provides a lot of charity care. "It's a potential significant source of additional revenue," says HHC President Alan Aviles.

Other hospitals have done the same: L.A. Care—a publicly run health plan in Los Angeles—has enrolled about 8,000 people through the California exchange, while the Henry Ford Health System in Detroit has signed up about 4,000 in its exchange plans.

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A closer look at MetroPlus

By the Dec. 24 deadline for receiving coverage on Jan. 1, MetroPlus—one of 10 companies selling exchange plans in New York City—had enrolled 18,397 members, accounting for about 32% of total New York City enrollments. Last week, enrollment reached 22,000 members, placing the corporation on track to hit its goal of 40,000 enrollees by the end of this year.

Currently, just 7% of the 1.4 million city residents treated by New York City public hospitals annually are privately insured, while another 58% are insured through Medicare or Medicaid, according to the Greater New York Hospital Association. A full 35% are uninsured, and about half of those residents are undocumented immigrants who do not quality for new coverage options under the ACA.

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The historical patient mix has created the perception that public hospitals should only be used as a last resort. In Medicare's Hospital Compare ratings, the city's public hospitals usually score lower on levels of patient satisfaction than private facilities, even though they score comparably on care quality measures.

HHC hopes that attracting more affluent patients will incent doctors who would not normally affiliate with public hospitals to join the MetroPlus network. If all goes well, HHC—which currently runs a $250 million annual deficit—estimates that the exchange plans could bring in $120 million in yearly revenue.

Signs of success?

By this week, officials said that 66% of MetroPlus customers had enrolled in a silver plan, indicating they had low-to-moderate incomes and would likely qualify for subsidies. However, they were surprised to find that 10% of enrollees opted for gold plans and 18% opted for platinum, suggesting higher incomes.

According to the Times, MetroPlus offers the lowest prices on the exchange for the top three standardized plans. This is mostly because patients will be covered only at the city's 11 public hospitals and four private hospitals.

In order to keep prices down, MetroPlus had to offer relatively low reimbursement rates for hospitals, Aviles explains. Although "we won't necessarily have concierge services," he hopes that the new customers will find that the city's public hospitals are underrated.

Nonetheless, he acknowledged that for some people, public hospitals would be unacceptable no matter how well they delivered care. "There's always a headwind in terms of how many hospitals there are in New York City and how many have designer labels," he says (Hartocollis, Times, 1/15).

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