Heinz and Health

Former state representative Matt Heinz is in the midst of the implementation of the Affordable Care Act

Tucson's Dr. Matt Heinz, who was an Arizona state representative for two terms starting in 2009, is currently working at the U.S. Department of Health & Human Services in Washington, D.C., as director of provider outreach. He is an internal medicine physician and also works at Tucson Medical Center, where he returns twice a month to continue his practice. I sat down with Heinz recently in Washington to discuss his job at HHS and the Affordable Care Act.

What are your duties and responsibilities as director of provider outreach?

I work under Health and Human Services Secretary Kathleen Sebelius. My job is to interact with the provider community—physicians, hospitals, medical associations, pharmacists, dentists. And nurses, of course. I mean, who spends more time with patients than nurses?

Actually, I'm doing two things. I'm providing information about the Affordable Care Act, answering the providers' questions about this very new program, and I'm also representing their concerns to Secretary Sebelius. In my job, it helps to be a practicing physician. That earns me a lot of credibility with the medical community.

Does your job involve travel?

Yes, I travel quite a bit. I just attended the National Rural Health Association conference in Las Vegas, which brought together over a thousand providers. From there, I went to the Gay and Lesbian Medical Association conference in Phoenix.

My second portfolio is interacting with national LGBT advocates. All of the new nondiscrimination regulations have a great effect on so many communities, but especially on LGBT Americans. People can't be told, "Hey, your 13-year-old is transgender, now your premium is $859 a month, just for this one individual, and we're also not covering any of the care." That's not possible as of the first of January this year, ever again.

Now that the official enrollment period is over, how do the numbers look?

We far exceeded expectations based on the rocky start back in October and November. I don't think anyone, myself included, thought it was possible to get more than maybe 6 million signed up. We are now over 8 million. It's starting to really tear apart a lot of the political arguments on the other side. We don't know these numbers, but even if 10, 15, even 20 percent for some reason don't pay their premiums or drop off at some point during the year, we're still going to have a number that exceeds the predictions of the Congressional Budget Office.

Why do you think the sign-ups exceeded expectations?

Basically, there was a tremendous pent-up demand. When affordable health insurance coverage options became available, people really did rush to them. Before the ACA, if someone had asthma as a child, the health insurance company could triple the premium because they were allowed to do that. Now that can't happen.

If you use the paper application to sign up for coverage, it's three pages. Why? Because they can't ask you anything other than how old you are and if you smoke or not. That's the only type of stuff they can use to change your premium. Have you ever had blood pressure issues? Have you ever had heart problems? Has your grandma or grandpa ever had cancer? They can't ask any of that stuff anymore.

Unfortunately, Medicare recipients have been regularly misinformed and are often scared about the Affordable Care Act destroying their coverage, but it's not true. In fact, the ACA provides Medicare beneficiaries with a no-cost annual wellness checkup, and for those who are enrolled in Part D (prescription coverage), they will no longer face the coverage gap because it will be completely eliminated by 2020 thanks to the ACA. As of July 2013, over 6 million seniors saved $7 billion in prescription coverage because of the new rules, and that figure continues to grow.

Is the 8 million figure an accurate count of the number of people who are newly insured under the ACA?

That 8 million figure only includes folks who signed up in any of the 14 state-based systems or the 36 systems we're running as a federal government. That's one number. But then there are 3.1 million folks who are young adults, 18- through 25-year-olds, who are still on their families' plans. That's not included in the 8 million. There's another very large number of people, probably about 5 million, we don't have the exact figures, who enrolled directly through insurance companies in ACA-compliant plans. True, some of them had policies before, but they were often ridiculously expensive or provided minimal coverage because of the earlier rules.

Then there's Medicaid. We have a report that came out showing 4.8 million new people are on Medicaid.

If you start cobbling together all those ACA and Medicaid numbers, you come up with a whole lot more than 8 million people.

Do you think more states will join in the Medicaid expansion?

I hope so. Some of our big states haven't joined yet, like Texas, Florida, North Carolina and Pennsylvania, or the numbers would be even higher. They're treating it as a fiscal or economic issue when it really should be a human issue. It's better to get people preventative coverage and screening so they don't have horrible, uncontrolled diabetes that causes their foot to rot off and get amputated because of infection, or they don't find out they have breast cancer until it's too late. It would be really great if we looked at it that way: that it's better to still have your foot. It's better to still have your mom.

Arizona's Gov. Jan Brewer did very well by the people of Arizona when she pushed for Medicaid expansion, saying it's the best thing to do for the people and it's the best thing to do for the taxpayers.

Is there any way for people to sign up for ACA now that the deadline has passed?

Yes, that's especially important. First Medicaid eligibility never stops. There's no open enrollment period. Whenever you qualify based on your family composition and income level, you can get on Medicaid immediately.

Second, with the ACA plans, if you go to healthcare.gov/sep-list online, that will break down the situations where you can continue to sign up. There are a number of qualifying life events, like a loss or change of job, if you turn 26 and are no longer on your parents' insurance, or if there was misinformation during the enrollment process and you can demonstrate that to one of our call center representatives.

If people want to find out if a procedure is covered, where do they go?

These are private health insurance plans, so you'd talk to your provider first—your doctor—or to the insurance company. Now, if you're having some issues, whether it's a discrimination issue or they say something isn't covered but you think it should be, then you can go to the regional HHS authority or to us here in D.C., but most of it is going to go through the issuer.