Health-Insurance-Plan

Despite efforts to scale back “Obamacare,” consumers who enrolled by Jan. 31 have health insurance for 2017, according to experts.

“Yes, all that is still in place,” said Eddy King, owner of Partners Insurance Advisors. “It would be extremely difficult to repeal 100 percent and cause people to lose coverage. Everything will remain the same for the following year.”

Also known as the Affordable Care Act, the law created a marketplace for people without health insurance to purchase plans. It offers tax credits, depending on income, to help pay premiums. The act also mandates everyone must obtain insurance or pay a penalty.

Critics say the law is dysfunctional, bringing huge losses for insurers and big premium hikes for consumers. Across Texas, Blue Cross Blue Shield raised its rates from 40 to almost 60 percent for 2017, according to documents filed with the federal government at healthcare.gov.

Meanwhile, proponents assert the number of insured Texans skyrocketed dramatically because of President Barack Obama’s health care law. Data shows from 2010 to 2015, the amount of uninsured people in the state declined by 1.7 million, according to a Department of Health and Human Services report published in December 2016.

On Jan. 20, President Donald Trump signed an executive order directing government agencies to “ease the burdens” of “Obamacare,” while the new administration and Congress work toward repealing and replacing the current law.

“A lot of individuals are concerned about subsidies, if subsidies (go) away, if the individual mandates (go) away, individuals might leave the marketplace, causing insurance premiums to rise,” King said.

King said PIA, founded in 2006, focuses on small businesses, and can add employers and start a plan at any time.

“Most individuals need an employer-based system for health insurance,” he added. “I’m hoping for changes — more tax credits, U.S. deductions for small business owners to give their employees health care insurance — that would be beneficial for everyone.”

In Bexar County for 2017, there are four providers offering 38 individual and family health insurance plans on the exchanges: Oscar Insurance Co. of Texas, AmBetter, Humana Health Plan of Texas Inc. and Blue Cross Blue Shield of Texas. The only plans available for purchase in Texas for next year are a health maintenance organization (HMO) or an exclusive provider organization (EPO).

Humana customers recently learned a dispute between their provider and the Tenet Healthcare chain of hospitals has limited their access to medical services since Oct. 1.

Tenet operates five Baptist Health System hospitals in San Antonio, including Baptist Medical Center, Northeast Baptist Hospital, North Central Baptist Hospital, Mission Trail Baptist Hospital and St. Luke’s Baptist Hospital.

“In the interest of our plan members, Humana has tried for many months to keep Tenet as a preferred medical care provider in the Humana network,” said Ross McLerran, a Humana spokesman. “Tenet unilaterally terminated its agreement with Humana for Medicare Advantage, commercial, Medicaid, individual major medical plans offered through the public exchange and Tricare product offerings as of Sept. 30, 2016.”

Baptist spokeswoman Patti Tanner offered a slightly differing view, stating they “will continue to be open to reaching an agreement that would restore in-network access to our health care providers for patients with Humana insurance.”

She added, “We have reached out to Humana and are waiting on them to respond to us and show interest in starting negotiations again.”

One issue some local Humana insurance holders face is they haven’t been able to access Baptist hospitals in-network since Oct. 1, meaning they’ll have to pay higher out-of-pocket costs if they want to continue using Baptist’s hospitals, doctors, urgent-care centers and other services.

McLerran said Humana has provided regular communications to its members affected by the Tenet network contract termination, sharing information with these folks on alternative hospitals, primary-care doctors and specialists in its health care provider network.

Tanner noted Tenet and Humana’s contract negotiations don’t affect emergency care at Baptist hospitals.

“It’s important to remember the following: emergency care access is not impacted,” she said. “You can continue to receive emergency care at our emergency rooms, regardless of our network status with Humana.”

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