With the upcoming federal requirement that nearly everyone have health insurance, officials at local medical clinics say they are preparing for an onslaught of additional patients.
But whether most of those covered by the federal mandate will seek coverage and services from local safety net clinics is the “$64,000 question,” said David Sanford, CEO of GraceMed.
“I don’t think anybody has a crystal ball to project how many folks of the estimated 42,000 in Sedgwick County who are eligible for the exchange will be compelled to sign up,” Sanford said.
The government is creating a special website at www.healthcare.gov for people to sign up for coverage – including Medicaid – if they qualify. Those who meet income requirements could also qualify for government subsidies to reduce the cost of insurance.
Kansas has opted to have a federally run online marketplace or exchange. Open enrollment is slated to begin Oct. 1, with coverage beginning on Jan. 1, 2014.
According to 2010 Census data, about 74,425 people in Sedgwick County – or about 17.1 percent of the population – are uninsured.
There are more than 326,000 Kansans who are uninsured and eligible to find insurance on the exchange, according to the latest figures from the Department of Health and Human Services.
Officials, however, have released no information on how much the insurance purchased on the exchange will cost.
The Kaiser Family Foundation, in an interactive online tool released Wednesday, estimates that the uninsured population in Kansas will decrease from about 380,000 to 186,000 under the Affordable Care Act. It also estimates that there will be an increase in Medicaid enrollment from 326,000 to 497,000 people in Kansas.
Schaunta James-Boyd, executive director of E.C. Tyree Clinic, said she thinks that even after Jan. 1 there will still be plenty of people who are not enrolled in either a private or government-run health plan .
“A lot of times, for our population of clients, they’re thinking of the day-to-day and trying to pay bills and put food on the table,” James-Boyd said. “It may not come up unless there’s a particular problem in their family.”
Education will be the biggest hurdle, she said.
“I don’t think that a wonderful job has been done on educating the general population about what’s going on and what’s going to need to happen,” she said.
“We have a lot of footwork to cover as far as educating them. Motivating them will be a whole other issue.”
The penalties for those who do not purchase insurance after the mandate takes effect Jan. 1 are not that severe, Sanford said, but they grow over time.
In 2014, those who do not have health insurance or coverage by Medicare or Medicaid will be fined $95 per adult and $47.50 per child, up to $285 for a family, or 1 percent of family income, whichever is greater, according to the Kaiser Family Foundation.
The penalty increases to $325 per adult and $162.50 per child, up to $975 for a family or 2 percent of family income, whichever is greater in 2015.
For 2016 and beyond, the penalty is $696 per adults and $347.50 per child, or us to $2,085 for a family, or 2.5 percent of income, whichever is greater.
However, the Centers for Medicare and Medicaid Services announced last month that people “who are ineligible for Medicaid solely based on a state’s decision not to implement the Medicaid expansion under the Affordable Care Act” will not be subject to the penalties.
Sheldon Weisgrau, director of the Health Reform Resource Project in Topeka, said that even though that portion of the population won’t be subject to the penalties, they won’t necessarily qualify for tax subsidies in the online marketplace either, leaving a gap of people who are too poor to buy insurance but “not poor enough” for Medicaid.
For those in the gaps, the safety net clinics will continue to provide health care, said David Gear, executive director of Guadalupe Clinic, which is affiliated with the Catholic Diocese of Wichita and does not accept insurance, only a $5 donation if possible.
“The underserved will still have a place to go even if they don’t fit into the model as it’s being designed,” Gear said.
Guadalupe is also gearing up for more patients because of a potential lag in the number of people who may enroll for Medicaid. The clinic currently has a person on location who helps people enroll if they’re qualified.
Gear said they opened a clinic in Planeview a year ago and are already planning to expand hours at that location to meet the need.
In 2003, Guadalupe saw about 4,100 patients. The clinic has already seen 4,400 patients so far this year, Gear said.
“The mandate will be a great net to catch those that are underserved, but there’s always going to be that next layer that’s still going to ultimately need health care,” Gear said.
So far, companies that intend to offer plans as part of the online exchange in Kansas are Blue Cross and Blue Shield of Kansas, Blue Cross of Kansas City, Coventry Life and Health, and Coventry Health Care of Kansas, according to Linda Sheppard, special counsel and director of health care policy and analysis for the Kansas Insurance Department.
Coventry is offering both a PPO and an HMO product, so that is the reason for the two different companies, she said.
It’s unclear whether any information on rates will be made available before the enrollment period begins. The plans will offer a range in coverage based on a bronze, silver, gold and platinum scale, with bronze being catastrophic coverage that more young people will likely seek, Sanford said.
GraceMed is one of about 15 safety net clinics in the state that will receive a total of more than $1.6 million in federal grant money to hire and train “navigators” to enroll people in the health insurance marketplace.
Sanford said GraceMed is hiring two employees to reach out to the more than 14,000 people who visited its clinic last year who did not have insurance.
It is also hiring two people to collaborate with other clinics, such as Hunter Health Clinic, as well as small businesses who might want them to come speak to employees who are not offered health insurance through the workplace.