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With ACA Signups Underway, Five Questions for Health and Human Services Official

Dr. Karen DeSalvo, Acting Assistant Secretary for Health in the US Department of Health and Human Services.
US Department of Health and Human Services

If you’ve been taking your time to peruse the insurance plans on Healthcare.gov, there’s only one week left to enroll for coverage that begins on the first of the year. (The exchanges will remain open until Feb. 15, however.)

More than 1.5 million people submitted applications to purchase health insurance plans on the federal exchange in the first two weeks of open enrollment season that started Nov. 15. About 360,000 people enrolled in a plan for the first time, according to federal data. People who purchased a plan on the federal exchange last year and do not sign up for a new plan in 2015 will be automatically re-enrolled in their current plan, but officials have urged consumers to revisit the site, because many plans and prices have changed.

There are many changes in store for the healthcare industry in 2015, so St. Louis Public Radio’s Durrie Bouscaren spoke with Dr. Karen DeSalvo, the Acting Assistant Secretary for Health for the U.S. Department of Health and Human Services.

The interview has been condensed for brevity and clarity.

Q:  The Missouri legislature has repeatedly voted not to expand Medicaid in the state, leaving about 139,000 people in a ‘coverage gap,’—meaning these people make too much money to qualify for Medicaid coverage and too little to receive a subsidy to buy insurance on the federal exchange. What do you see as the federal government’s role in addressing those gaps? 

This is a major challenge for some of the most vulnerable people in all of our communities. For reasons that are right now in the control of, not the federal government entirely. Some of the most poor and at-risk people in our communities don’t have access to coverage because they’re not eligible for subsidies on the marketplace.

We need to really think through how we come to some better solutions. There are some great examples where states, irrespective of the political party of their leadership, have found a way that works for the people of their communities and their states, and the federal government has really leaned in to work for them.

[Sylvia Burwell, Secretary of the U.S. Department Health and Human Services] has been, I think, a great champion of seeing that we are as flexible as possible as a federal government.

Q: Our neighbor to the east, Illinois, did expand Medicaid. So, here in St. Louis we’re expecting to see some differences in the number of people who have coverage compared to across the river. Do you think the federal government will have a role in addressing the disparities between states that do and don’t expand Medicaid?

This is a really important, longer term policy question for our country. We do, of course, have state boundaries, and we at the federal level respect those state authorities. Of course, when you get to the ground people travel across state lines. They might live in one state and work in another.

There’s lots of ways that states have been thinking through how to expand coverage, and also how to expand better access to care. Federally qualified health centers do provide an additional option for access to care. It’s not coverage, but its access. Congress did increase funding for federally qualified health centers; these are community health centers located across the country that have been able to expand services, expand sites, to meet the needs of those who might continue to be uninsured.

It’s a great option for primary care, and sometimes mental health and dental services. On the other hand, it doesn’t provide the full range of coverage benefits that most of us would want to expect or have people enjoy—what I mean by that is hospitalization or catastrophic coverage.

Q: You also serve as the National Coordinator for Health Information Technology. This next year, 2015, will be the first year that doctors will be penalized if they don’t keep patient’s medical records in an online database. Many physicians in smaller practices and rural areas say the electronic records cost too much to install and maintain. Is this something your department will be addressing? How?

It was important to raise the floor and not create a digital divide. Last spring we put out a flexibility rule that gave providers an option to continue using the existing electronic health record they have, or to upgrade. Knowing those things take money and time, we wanted them to have some options about advancing, and not have to worry in the short run about how they would continue to progress.

I think the bottom line is that consumers -- patients -- have a right to their health information. They need to be able to access it, for themselves, for their own care coordination, to make empowered decisions about their own health and healthcare. It is the responsibility of the healthcare system to see that that’s available in a timely and affordable way to everybody in this country.

Q: The Supreme Court has said it will rule on King vs. Burwell, a case that questions the legality of offering income-based subsidies to help people buy insurance on the federal exchanges. If the court rules against the subsidies, the overall cost of Missouri plans would go up substantially for people buying insurance on Healthcare.gov. Is your department making plans to address this situation if the Supreme Court rules that way? What are they?

We know that about six out of 10 people who took advantage of the marketplace were able to get coverage for less than $100 a month because of the opportunity for supports. We believe that the intent of the law is to help support everyone to have an opportunity to have access to coverage, and we look forward to having that opportunity continue for people in this country.

Our belief is that the intention for the subsidies is to hold fast. And so that is what the Secretary Burwell and the administration is continuing to look at. But we want to do everything we can to see that people can continue their coverage and that they have access to great quality care.

Q: Anything else you’d like to add?

December 15th is the day for the folks we want to go online, take a look at new choices. Missouri has new choices for health issuers, for health plans. People may be able to find something that’s more affordable, they may be able find something that better suits their health needs. Don’t take it for granted and auto-enroll. Take the opportunity to make sure that you’re shopping and getting the best deal for your money, and that all your information is correct.