Jane Yule is a nurse practitioner working in rural Nebraska. She became interested in health care reform because so many of her patients are uninsured. “I actually thought that when the health care law passed everyone just magically got insurance,” she said. But the reality, she learned, is a little more complicated.
So Jane began to educate herself. “Now I’m able to give my patients information about where they can start looking now to get help, such as the high-risk pool – and start giving them information on what’s coming up,” she said.
One big thing coming up is the establishment of health insurance exchanges. An exchange is an insurance marketplace with the goal of helping individuals and businesses access affordable and quality health insurance.
I met Jane at a recent presentation about the exchanges in South Sioux City. There, representatives of the state Department of Insurance explained that exchanges will work kind of like a farmers’ market: they’ll be a neutral place where insurers lay out their plans and consumers can shop and compare.
The Affordable Care Act requires states to have an operating exchange by January 2014. Eric Dunning, of the Nebraska Department of Insurance explained, “It’s not a question of whether we have an exchange or not – but whether its run by the state, by the federal government or a combination of both”. Nebraska, like the rest of the country, is now deep in the process of finding the best formula their resources and population.
Jane sees new competition in the health insurance market as a good thing for her rural patients. “As individuals we don’t have any leverage at all in terms of marketplace competition to get better rates,” she said. Jane and her husband, a farmer, carry their own private insurance. For many rural people, this private insurance is totally unaffordable. “A lot of the farmers I see just don’t carry insurance,” said Jane. “They’re just hoping they make it to Medicare age before they get sick.”
In addition to competition, Jane is looking forward to the individual guidance. While she tries her best to give advice, Jane hopes that her patients will benefit from the groups specifically trained to guide individuals through the healthcare process, called “navigators.” State and federal government are still negotiating who exactly these will be. Navigators could be nonprofit organizations, churches, community groups or insurance agents. Groups with rural experience will be critical in ensuring that the rural uninsured have access to the exchange.
For now, Jane says she sees a lot of people waiting for a change to come. “The patients I see – because they’re coming into our clinic – don’t have health insurance. So what’s happening is that they are postponing care,” she said. “If something’s going on and it’s not killing them, they are just waiting. Waiting for someone to get a job, or the new health care to kick in. Just waiting day to day.” And while they wait, they only get sicker, often arriving back at the clinic or in the emergency room with conditions that require more extensive treatment.
So will health insurance exchanges be worth the wait? It’s not time that will tell, but the active participation by people like Jane -- and people like you. Find out more about the health insurance exchanges, look for upcoming meetings, and speak up to ensure the exchange is designed to meet the specific needs of rural communities.
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