Local health centers preparing for new insurance marketplace patients, face challenges
by Patrick McCreless
Oct 02, 2013 | 3634 views |  0 comments | 86 86 recommendations | email to a friend | print
Anniston Quality Health Care CRNP Kristi Francis looks into a patients ear at the clinic on Noble Street in Anniston. Photo by Stephen Gross
Anniston Quality Health Care CRNP Kristi Francis looks into a patients ear at the clinic on Noble Street in Anniston. Photo by Stephen Gross
Maxine Bloodworth watched as her granddaughter ran around her chair in the lobby of the Anniston Quality Health Care on Wednesday afternoon. The 76-year-old Blue Mountain resident had just received a checkup and prescription drugs at the community health center, which provides primary care regardless of patients' ability to pay. About five other patients were waiting for care, but plenty of seats in the room were still empty.

For the last five years, the community health center in the 1300 block of Noble Street has covered Bloodworth's medical needs with little wait time, much to her satisfaction.

"The personnel are so friendly," Bloodworth said. "The wait is a little longer than some other places, but the doctors talk to you and listen to you."

However, Bloodworth's experiences could soon change.

Americans this week began enrolling in federal insurance marketplaces, key components of the 2010 Affordable Care Act that are mainly to help uninsured residents afford health care. Community health centers have undertaken federally funded expansion efforts in the past three years to accommodate for the growth of newly insured patients. However, Alabama's decision not to expand Medicaid as stipulated by the Affordable Care Act could mean greater patient growth and financial burdens than local community centers had anticipated, some health industry experts say.

As stipulated in the Affordable Care Act, Congress in 2011 began a five-year, $11 billion plan to expand the federal community health center program so it could handle the increase in patients buying insurance in the marketplaces. The Affordable Care Act also offered states three years’ worth of free federal money to expand their Medicaid programs to cover more low income residents who will still be too poor to afford insurance in the marketplaces. Alabama was one of several states that opted out of the Medicaid expansion.

"As a result, we're going to have more people coming into community health centers now than ever before," said Dr. Mickey Trimm, associate professor of health care management at the University of Alabama at Birmingham. "It's a serious problem ... they're doing everything they can to try to get ready for this."

Trimm said that to pay for the Medicaid expansion, the government will start cutting back on payments that help hospitals cover the costs of treating uninsured patients. With fewer Alabama hospitals able to pay for the care of the uninsured and with no Medicaid expansion, many of those patients will end up at community health centers, Trimm said.

"That's going to leave community health centers as major players in stepping up for that," Trimm said.

Trimm noted that if state community health centers are overburdened in the coming years, some patients could slip through the cracks due to excessive wait times and not receive the care they need, even those covered by Medicare and Medicaid. He said that while community health centers will always accept Medicaid and Medicare payments, many private practice doctors do not.

"Many doctors don't accept Medicare and Medicaid because they don't pay as much as say Blue Cross Blue Shield," Trimm said.

Bloodworth, who is covered by Medicare and Medicaid, said part of the reason she goes to Anniston Quality Health Care is that it accepts payments from such programs.

"I've experienced that — doctors that don't accept Medicare and Medicaid," Bloodworth said. "But a lot of old people have low incomes and they couldn't afford to go to a doctor if they didn't have (Medicare and Medicaid)."

Wayne Rowe, CEO of Gadsden-based nonprofit Quality of Life Health Services, which owns Anniston Quality Health Care, along with similar facilities in Talladega and Cleburne counties, said the centers' expansion efforts have proceeded well.

"We've been expanding services," Rowe said. "We've had to hire some more personnel."

Rowe said the Anniston facility offers family medicine, dentistry, eye care, pharmacy and X-ray services. Operation hours were recently expanded there to provide service to more patients.

"And for the Anniston area, we're in the process of looking for a new facility to accommodate the patient demand we have now," Rowe said. "The wait time is still a little longer than we'd like ... hopefully we'll be able to secure another facility in the area soon."

Rowe said that despite the state's decision not to expand Medicaid, the Quality of Life facilities will be ready for patient growth next year and the increased cost of caring for more uninsured residents.

"Because of the marketplaces, now many of our uninsured will become insured and we'll be reimbursed for the services we provide," Rowe said.

Rowe said that about 35 percent of Quality of Life's patients are uninsured each year, while another 15 percent have private insurance and the rest use Medicaid and Medicare.

Amy Simmons, director of communications for the National Association of Community Health Centers, said that in addition to some states not expanding Medicaid, many community health centers have in recent years had to deal with federal funding delays that have slowed some expansion efforts.

"There have been some challenges," Simmons said.

Despite those problems, the community health center system is moving forward and will be ready for the patient expansion next year, Simmons said.

"People need to have good health coverage and that's what community health centers stand ready to do," Simmons said.

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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