Navigating health care’s turbulent waters

The Affordable Care Act debate in Washington could mean big changes for health care down the road in Michigan.

What will happen to Michigan residents newly insured by the Obamacare-funded Medicaid expansion in the state? Will those with pre-existing conditions lose guaranteed coverage? What happens to students under 26 covered now?

Changes in the ACA can also mean big changes to insurance and hospital operations in Detroit and Michigan. Currently, the Medicaid expansion in Michigan is projected to add at least 30,000 jobs in the state each year from 2017 to 2021, and increase personal income more than $2 billion each year, according to the Commonwealth Fund, a private foundation that promotes improved and efficient health care. The added economic activity is projected to yield $145 million to $153 million annually in state tax revenue.

Richard Smith, MD, Henry Ford Hospital's vice president of physician outreach, an obstetrician who's been practicing in Detroit for more than 40 years, points out that 600,000 Michiganders got health care coverage, and unpaid medical bills and charity coverage dropped by half after enactment of the ACA.

He said staying connected with a doctor, and health care system that uses technology to communicate to you and among providers, is key to staying on top of health care coverage. In addition to helping you manage your own care, that communication helps lower costs across the board.

For instance, Henry Ford Medical Group, the practice representing more than 1200 Henry Ford doctors; Health Alliance Plan (HAP); Ford Motor Company; Fiat Chrysler Automobile; General Motors; Blue Cross Blue Shield of Michigan; Medco Health Solutions, and CVS Caremark Corporation worked together to create an Internet-based, e-prescribing program that lowers costs, improves safety and increases compliance for patients who need medications.

"Twenty-first Century care involves technology; the 19th Century system doesn't work, and you must maintain your relationship with your physician," said Dr. Smith. "If there are changes down the road, your best friend will be your physician, who knows you, your medical history and how the system can help you."

After navigating more than 25 years of changes in the health insurance industry, Claudia Swink, director of individual business for Health Alliance Plan, says people should stay calm as the health care debate continues.

"Only one thing is certain right now - nothing has changed yet," said Swink.

As a general rule, consumers should always take advantage of all of the preventive services currently available under their plan, including health and wellness tools, annual checkups and screenings, said Swink.

"If you don't take advantage of these important screenings, such as mammograms and colonoscopies, then you are literally leaving money on the table, not to mention that early detection could save your life," said Swink, adding that health insurance professionals can help you understand what your plan offers. If you or your family have questions related to your coverage due to changes in ACA, those same experts can help you determine the best coverage to meet your needs, she added.

It always pays to know your plan, and whether you're paying for benefits you're not using, she recommends.

"You'd be surprised," said Swink. "One example is those who prefer a PPO over an HMO because they want the flexibility to go 'out of network' if they want to. You pay extra in monthly premiums for this flexibility. If all of your doctors and hospitals are in the HMO network, why would you pay more? If you're traveling and have an emergency, then you can always see an emergency physician wherever you are."

On the medical side, doctors recommend you do everything in your power to stay healthy and avoid long-term medical issues like diabetes and obesity that can drive up costs. That should include exercising, eating green, leafy vegetables and other healthy foods, not smoking, not drinking excessively and taking medications as prescribed, said longtime Henry Ford pediatrician T. Jann Caison-Sorey, MD.

"People who have the ability to improve their health should work as hard as they can to do so, regardless of changes in insurance," said Dr. Caison-Sorey. "And the best way to promote personal health is to keep it at the top of one's 'to do' list every day."