by Gina Luna
- The Capitol Hill Times -
In five days, a new crop of American citizens will enter the world of health care and general practitioners. A freshly laminated insurance card slipped into their wallets. And while many people across the United States struggle to enroll for coverage, Washington State residents fare better than most.
Recently, I sat down with Daryl Edmonds, the president of Amerigroup Washington, to learn what our state is doing right. Amerigroup, the leading provider of health care solutions for public programs in Washington State – and serving upwards of 4.5 million people throughout the nation by connecting members to Medicaid and other Qualified Health Plans (QUHP) – is part of the equation.
Let’s start with you. How did you get into your field, and then Amerigroup Washington?
In the 80s, the Health Maintenance Organization industry was just getting started. I was looking for a growth industry, something that was new, and landed a job there. Opportunities were presented along the way, and I choose to move with them.
Before this move, I had worked on the commercial side of the business for my entire career, and was successful doing that, but I wanted to do something that I felt was more significant. Working with the Medicaid population and trying to help people who need help – who need access to health care and help coordinating care – fit that desire. At Amerigroup we ask how we can get people to a physician, get them the care that they need, and ensure that the quality of care is good; that’s more significant to me than the business end.
Amerigroup started serving members in Washington State in July of 2012, and is already a health plan leader in the state and country; what are your company and Washington State doing better regarding the Affordable Care Act?
The state of Washington chose to build its own health exchange. When you compare the Washington Healthplanfinder to a lot of the other states that chose to do health care on their own or let it be a federally facilitated exchange, Washington’s exchange is working really well.
Since October 1, the number of people who have been enrolled is now 213,759 (December 24); so much of that is Medicaid expansion. In Washington, there’s a system that people can get on that’s working, without encountering problems at the federally facilitated screen. That’s huge.
Second is the patient assistors who help people navigate the system and enroll through Medicaid or QUHP. There are a lot – over 1,000 patient assistors – around the state. People wanting to enroll can go to them and ask, “Can you help me to find out whether or not I’m eligible for Medicaid?” or “Can you help me determine if I’m eligible for QUHP, and then show me how I can select one?”
So, the “failure of Obamacare” has less to do with the care and more to do with a bad website?
Before the ACA allowed for Medicaid expansion, the state of Washington choose Medicaid expansion, got in front of the decision and promoted it. As a result, people who need to enroll are going to have health insurance for the first time in years, some for the first time in their entire life. The realty is, for the people who have never been able to have health insurance, this is life-changing.
What’s going on in the rest of the country?
I haven’t followed every state’s actions closely, but I would put Washington in the top tier of states, if not the top one, in the way that they have executed this. I have talked with people in a variety of other states, and the time that it takes for them to get online or access the system and determine whether they’re eligible or not – it takes hours. And these are people who are computer savvy; it’s not like they haven’t seen a computer screen before or that English isn’t their first language.
It seems that there is a divide between liberal and conservative states.
States had the choice to build their own system or let the federal government do it.
More states allowed the feds to do it, and that’s where we have been reading about people having issues regarding access to enrollment.
If I want to enroll or find out if I qualify, what do I need to do?
Go online to wahealthplanfinder.org. Or, there’s also a toll free number that you can call for support (1-855-923-4633). They’ll determine your eligibility (Medicaid or QHP). If you’re eligible for QHP, then you’ll find out if you’re eligible for a subsidy for that premium.
And there won’t be a robot at the other end?
There is a live person who you can speak with.
What happens January 1?
Some have been receiving care in the emergency room or a community health clinic, but probably not routine care. So, there will be an influx of people showing up, and we need to ensure that people have the best access to care.
We have talked with a lot of physician organizations. Some say, “We’re pretty much at capacity,” while other physician practices have said, “We have been planning for this for two or three years; we’ve hired physicians, physician extenders, nurse practitioners… and we’re ready. In fact, we want patients, and we’re out-marketing ourselves to bring patients in.”
No capacity problems, there. We’re ready.