Informing people about their health insurance choices, signing them up for coverage and making the economics of the plan work are among challenges local health care providers said they see with implementation of the Affordable Care Act.

“The most important opportunity here is the ability to get people who have otherwise not been involved in the system,” said Steve Blumberg, senior vice president of AtlantiCare Health Solutions, which reports 37,000 emergency-room visits from uninsured patients annually. “The more the population participates in the model, the better it is for everybody because you spread the risk out and create a model where more people have access to the care.”

The act, which mandates that almost everyone carry health insurance by 2014, is taking effect in phases. Following Gov. Chris Christie’s veto of a bill that would have established a health exchange in New Jersey, the state is among the nearly 20 jurisdictions leaving the creation of an exchange up to the federal government. Under the law, individuals and small businesses use health exchanges to shop for and purchase insurance.

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For the consumer, having the exchange run by the state rather than the federal government likely will make little difference, except that New Jersey will have to wait to see what the federal exchanges will look like, said Dorothy Gaboda, associate director for data analysis at the Center for State Health Policy at Rutgers University,

“The can has been kicked down the road,” she said.

The U.S. Census estimates that 15 percent of state residents younger than 65 have no health insurance, with some areas, such as Cumberland County, seeing levels of nearly 20 percent. Areas with high unemployment and low income tend to have higher rates of uninsured, such as in urban areas where there are more undocumented immigrants, researchers say.

“They tend to be areas where there are a lot of recent immigrants,” Gaboda said.

Undocumented immigrants are not eligible for health insurance under the Affordable Care Act.

About 20 percent of the uninsured population in the country are noncitizens, according to The Kaiser Commission on Medicaid and the Uninsured. Farmworkers also have high uninsured rates of 36 percent, according to the nonprofit.

Even when individual health insurance is mandated in 2014, researchers believe 9 percent the population will continue to be uninsured, according to Rutgers University’s Center for State Health Policy. Some will be undocumented immigrant, and others would be willing to pay the penalty rather than buy coverage.

Insuring more people will depend in large part on outreach and public education efforts, all of which also are mandated by the Affordable Care Act, observers said.

“The real opportunity is to get more and more people to participate in their health care, and if we can get more people to participate, we’ll ultimately drive down costs,” Blumberg said.

Rich Miller, president of Virtua, a health care system with headquarters in Marlton, Burlington County, said some providers also are starting to take a different approach to health care, particularly when it comes to caring for patients with chronic conditions such as hypertension and diabetes.

Patients who end up in the hospital with conditions, such as congestive heart failure, likely would have been able to avoid spending a week there if they had been regularly taking medication, Miller said. Virtua has started a pilot program in which it partners with a home health care agency to make home visits, which may be less costly than the week’s hospital stay.

“The goal is to keep them well at their home, check on them regularly and make sure we can control that (chronic) condition,” Miller said.

One concern some hospitals have is the amount of reimbursement they will receive in the future for uninsured patients who use emergency room services. Hospitals across the state receive a “charity care subsidy” that helps to offset the cost of caring for the uninsured. Once health exchanges are set up and the individual insurance mandate takes effect in 2014, that subsidy likely will go away or be greatly reduced, possibly putting hospitals in a bind, Miller said.

If not enough individuals who use the emergency rooms carry insurance — if they choose to pay a penalty instead — hospitals will end up having to cover those costs and won’t be able to rely on the charity care subsidy.

“That’s going to be hard for a lot of hospitals,” Miller said. “You have to have that coverage to offset the drop in charity care reimbursement.”

Kerry McKean, a spokeswoman for the New Jersey Hospital Association, said the hope is for the subsidies to continue for at least a short time after health exchanges are set up.

“Even with the passage of the Affordable Care Act, there’s going to be an important period where we are bringing people on board,” she said. “We hope the addition of more insured individuals will reduce the need for charity care, but that remains to be seen.”

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