The ACA in the Southeast: Adapting to the New Landscape

The southeast has largely reacted to the ACA differently than much of the country.

The southeast states could need assistance with health claims in 2017.
December 8, 2016

While the Affordable Care Act dramatically altered the healthcare landscape across the entire U.S., its impact has varied significantly between regions. Case in point: the Southeast.

With exchanges leaving, rates fluctuating and tax credits unused, hospitals in this region must meet goals, cut costs and streamline claims processes without overcomplicating things or losing time. To better adapt to this new but fast-changing environment, hospitals need to keep their work cycles manageable. Otherwise, the ACA’s particularly chaotic effect on the Southeast will lead to tremendous efficiency complications. Let’s take a closer look at four of the different ACA-related factors that could disrupt standard hospital performance in the Southeast.

Medicaid (un)expanded

While the ACA attempted to broaden the reach of Medicaid, the Supreme Court’ s decision in National Federation of Independent Business v. Sebelius ruled the federal government could not mandate that states accept this expansion – and states in the Southeast have proven particularly unwilling to embrace the extension voluntarily. In total, 31 states have expanded coverage under the ACA.

According to the Kaiser Family Foundation, most of the southern states, including the Carolinas, Florida, Georgia and Mississippi, opted out of these expansions. As of October 2016, the list also included further west states, such as Texas, Oklahoma and Missouri.

“To keep their work cycle manageable, hospitals should pay specific attention to workers compensation and auto accident medical billing processing.”

Insurers leaving the market

Buyers in the Southeast face the possibility of fewer—or at least different—choices for their areas given changes to the law and business coverage.

The Associated Press reported residents in Virginia may find themselves with only a single insurer. As many as 7 million people were thought to be either outside healthcare markets or ineligible for specific income-based assistance. Premiums are also set to go up by a full quarter on average in several southern states, and such a significant increase will inevitably cause major disruption throughout the healthcare sector.

New expectations in 2017

It’s impossible to avoid the way recent political events have also brought the future of the ACA and general healthcare coverage into question. President-elect Donald Trump and his surrogates have
openly criticized the Act and promised to repeal it.

However, Trump has also admitted to favoring certain aspects of the care model, and some have questioned how long it would take for Trump to accomplish his goal. Depending on whether his administration changes the act, states which currently opposed elements of the law could find themselves changing their minds if it takes a different form. In any event, Trump’s win has certainly put a question mark over the actual future of the law and whether it will be completely replaced. Given the current level of chaos surrounding the ACA in the Southeast, these unknowns pose even greater challenges for hospitals in this region than those in the rest of the country.

More insured people on exchanges

Finally, there’s the growth of different covered residents to contend with. Reuters recently reported on the more than 1 million members set to receive health insurance through exchanges in the coming year. While this is lower than anticipated, the government still expects 11.4 million people to sign up each month next year.

In those states where confusion reigns regarding the ACA—i.e. the Southeast—many people on these exchanges may not fully understand their coverage. MPB Online reported 22,000 insured Mississippi residents may be missing out on tax credit benefits for which they qualified, for example. This lack of clarity further complicates the claims process not just for patients, but for hospitals and insurers as well.

Simplifying when possible

Considering all of this, hospitals in the Southeast should look to streamline and cut down the costs of their operations wherever possible. One of the best options: outsourcing workers compensation and automotive insurance revenue cycle management to a dedicated partner. While these two areas represent a small portion of hospitals’ total revenue cycle, their level of complexity requires a disproportionate degree of expertise. Working with a partner like PROMEDICAL simplifies matters, minimizes the risk of missteps and maximizes claim success.