According to a new report, The Uninsured at the Starting Line in California by the Kaiser Family Foundation, Community Health Centers will “remain critical providers of care to vulnerable populations under the Affordable Care Act (ACA).” The report, released at a briefing sponsored by the Kaiser Family Foundation and Blue Shield of California Foundation, set a baseline for creating a before and after picture of how the ACA would impact availability and affordability of coverage using California as a testing ground.
Why California? The state was one of six that opted to expand coverage early to low income adults in preparation for the landmark law. How that effort (which was accomplished through a Medicaid waiver) and health reform have played out among Californians will help inform policy makers about the early stages of coverage expansions to a large population with high numbers of uninsured. Before the implementation of the ACA, nearly 7 million Californians – 21 percent of the state’s nonelderly population – were without health insurance coverage. The biggest barrier to getting coverage was the price of it – few people could afford it. Also, getting care was another challenge for the uninsured. Only 49 percent of uninsured adults report they had a usual source of care. California is up to the task of reversing that trend.
The report highlighted the importance of health centers in the healthcare system as well as to the success of the ACA in key areas, such as outreach and enrollment and the delivery of care. The report noted that although coverage may force people to change providers or choose new ones, the healthcare safety-net will continue to provide access to care to vulnerable populations. However, the report also cautioned “as uncompensated care funds diminish over time, these safety-net providers may be strained to meet demand in the face of shrinking resources.”
The findings also underscored that it is important health centers continue outreach and enrollment activities to reach people who are unconnected to health and social services and also to address gaps in coverage which low-income populations often confront.
“We are not yet experiencing the influx of patients many thought would flood our health centers on January 1, but we anticipate that will come as more people gain access to coverage and need services,” said Kaiser briefing panelist and NACHC Chief Medical Officer Ron Yee. “Health centers are reporting a lot of interest from people about connecting with coverage and learning what their options are. There are people who are coming to our health centers who have never had an insurance card before and our job is not only to assist them with enrollment but to show them how to effectively use that coverage.”
Educating the newly enrolled on how to use their coverage effectively means also helping them establish medical homes, in places like health centers, where they can receive regular preventative care.
“If a patient’s only medical care has been through the ER, chances are they don’t have a doctor-patient relationship and will continue to stick to what’s familiar,” said Yee. “Our job is to show them the value of having a medical home like a health center where their non-emergency health needs can be addressed before they become an emergency.”