DeKalb panel discusses Affordable Care Act

By Jessie Kern

Three speakers addressed DeKalb residents during Thursday’s Affordable Care Act forum to inform the community about potential changes to their health care.

The forum focused on conversations being had around the country regarding the current state of health care and the effect the repeal of the Affordable Care Act would have on DeKalb residents.

DeKalb County Health Department officials are monitoring shifts in health care closely because it is likely to impact most of DeKalb’s residents, especially low-income individuals, said Lisa Gonzalez, DeKalb County Health Department public health administrator.

Gonzalez said the health department’s assistance in enrolling residents in health care programs is a vital role in public health but it also offers aid in a variety of other services as well, such as family case management and childhood immunizations.

“Even before the Affordable Care Act was passed, the health department has been a resource for working with our residents to really help them navigate the local social services and health care services,” Gonzalez said.

The Affordable Care Act was implemented in 2010 as an attempt to benefit Americans through the expansion of Medicaid. The Affordable Care Act also ensured individuals could not be turned away from insurance companies for pre-existing conditions.

Gonzalez said a repeal of the individual mandate is estimated to decrease the number of uninsured Americans.

“The congressional budget office estimates that will result in 13 million fewer people having health insurance over ten years, and that premiums will rise 10 percent more per year than without this change,” Gonzalez said. “And, so obviously, we’re watching that very closely, and we have some concerns.”

Meghan Cook, DeKalb County Community Mental Health Board board member, said changes to the Affordable Care Act could affect those with mental health concerns and substance abuse from receiving treatment.

Cook said before the Affordable Care Act passed, people with a mental illness diagnosis could be denied because providers were given the option to deny patients with pre-existing conditions.

“If you received treatment maybe when you were 18, and then again need treatment when you’re 30, that’s seen as a pre-existing condition prior to the Affordable Care Act,” Cook said. “And then somebody could be denied or denied eligibility for insurance under that pre-existing condition.”

Cook said the DeKalb County Community Mental Health Board provides services to those suffering from, or are at risk of, developing mental health or emotional disorders, substance abuse disorders, as well as those diagnosed with developmental disabilities.

“So, in particular, the uninsured population  folks who are uninsurable through private or public insurance policies — are those who we’re able to really help out,” Cook said.

A key component in the presentation focused on Illinois being one of the expansion states for Medicaid as part of the Affordable Care Act.

“Many adults weren’t able or eligible for Medicaid previously, with the expansion that was offered through the Affordable Care Act they then became eligible to apply for coverage,” Gonzalez said.

Health care providers need to have a mix of patients to be able to cover their costs and will, at times, turn away Medicaid patients because of how their insurance plan covers costs.

“I think there’s always been some access to care issues with Medicaid patients, but it has to do with the fact that Illinois is 49th of all states in Medicaid payment rates,” Gonzalez said.

Kevin Poorten, Northwestern Medicine West Region president and Northwestern Memorial HealthCare senior vice president, said before the passage of the Affordable Care Act, Blue Cross Blue Shield of Illinois, the only insurance company offering plans in DeKalb, was making more that $1 billion a year, which he thought was money that could be going back to the providers so they can make more than five cents for every dollar.

Poorten said despite improvements made to health care, 40 percent of the hospitals in Illinois lose money and about one-third of the facilities operate at a breakeven level.

“Which is why certain providers are like, ‘I would love to take care of Medicaid but here’s what I’m telling you, I can’t afford to take care of the Medicaid patient because I’m not even covering my cost, or being reimbursed,’” Poorten said.