Obamacare could mean coverage for 38,000 uninsured county residents
Mar 03, 2013 (Ventura County Star - McClatchy-Tribune Information Services via COMTEX) --
In a surge that begins Jan. 1, nearly 40,000 uninsured Ventura County residents are expected to gain access to doctors, clinics and care.
Whether the theory driving federal health care reform materializes locally or falls short depends largely on whether there are enough doctors to provide care.
Leaders of an area Medi-Cal system and a Ventura County health care network think the answer is yes. They point to expansions of clinics designed for low-income patients, the recruitment of doctors and the strength of an existing safety net that some leaders consider among the best in California.
One doctor can provide care for 2,000 to 2,500 patients because some will be healthy and won't require extensive care, said Dr. Robert Gonzalez, director of the Ventura County Health Care Agency. That means 16 to 20 doctors could take care of the county residents expected to be newly insured over the next several years.
"It's doable," he said, noting that some of the burden may be assumed by private doctors and that physicians could be augmented by nurse practitioners and physician's assistants.
"You have to look at the whole of the county's providers. I think we're in pretty good shape."
Observers say the safety-net systems already operate at capacity or near it. They say patients already wait for care. They predict the patients will wait longer, come Jan. 1.
Dr. Danielle Onstot, an Oxnard pediatrician, said she had to intervene on behalf of a mother of a sick 3-month-old who was told a safety-net doctor would not be available for more than a week. She thinks such problems will increase when newly insured patients want care.
"I think there will be huge ones," she said of access issues.
Onstot said problems will ramp up before health care reform's rollout when children covered by the state's Healthy Families program are transferred to Medi-Cal as part of a budget cut. She sees patients in the Healthy Families program, but because of lower payment rates doesn't see Medi-Cal patients except in emergency situations.
When Obamacare funnels more patients into Medi-Cal and the new insurance exchange, people will have more difficulty finding doctors, she said.
One reason predictions of the future vary wildly is because of a cluster of wild cards that would startle a poker player.
It's unclear whether the burden of running an expanded Medi-Cal will fall on counties or on existing managed-care systems that run the program now. Doctors have been promised increased pay for seeing Medi-Cal patients but are still waiting for the money to come. Safety-net systems worry their funding may be cut because of the theory that they'll have fewer uninsured patients to cover.
Even the numbers are speculative. According to projections from UC Berkeley and UCLA, about 30,000 additional Ventura County residents will enroll in an expanded Medi-Cal program from 2014 to 2019. As many as 12,000 of them already receive medical care through a Ventura County Health Care Agency safety-net program called ACE.
An additional 40,000 Ventura County residents are expected to qualify for insurance coverage discounted through federal subsidies. Roughly half have been uninsured in the past, according to one of the researchers involved in the projections.
That means about 38,000 uninsured people could be covered. Some providers predict many of the new patients will have multiple issues and will want care as soon as they can get it.
"All of our reports are saying there are not enough providers to see patients," said Dr. Anil Chawla, medical director of the Clinicas del Camino Real network of health centers. The county's Medi-Cal network "is already a loaded system. ... It's going to create problems."
Medi-Cal in Ventura County is administered by a public managed-care organization called the Gold Coast Health Plan. The plan contracts with 205 primary-care doctors and 344 specialists. Nearly 60 percent of the primary-care physicians come from public and private systems designed to serve low-income patients.
"Right now, we don't have any access problems," said Dr. S.N. Charles Cho, the 78-year-old doctor who came out of semiretirement to serve as Gold Coast's medical director. He thinks the system will be able to handle the increased patient load from the Healthy Families transition and Obamacare.
"I think we have the system in place to accept the challenges in the increase," he said.
His confidence is rooted in a safety net made up of a county-run network of hospitals and private clinic systems run by Clinicas del Camino Real and Community Memorial Health System. They have 55 clinics and centers throughout the county.
That system is one of the best in California, said Gonzalez. Asked about crowded county clinics, he cited expanded buildings, extended hours and the hiring of more physicians -- all aimed at handling growing patient demand.
"To be at capacity or to be at the edge of capacity is probably the most financially efficient way of providing services," he said, "because the opposite is to have providers sitting in the office idle, without patients to see."
Gonzalez said more doctors will be added if the number of patients from federal reform warrants it. He said nurse practitioners and physician's assistants will be used to ease the burden on doctors.
The most crowded clinic in the county network -- possibly the busiest site in all of Ventura County -- is the Las Islas clinic adjacent to an Oxnard mall. New patients may wait two months to see a doctor. The clinic doesn't have enough physical space to accommodate more physicians.
"I anticipate that our challenge will only grow," said Dr. Miguel Cervantes, medical director of Las Islas. "I think the patients who will have the hardest time are those who currently do not have a primary-care provider, whether they are insured or uninsured.
"It's that 30-year-old who has never seen a doctor and now has insurance."
Health care reform also brings increased pay to primary-care doctors for seeing Medi-Cal patients, raising rates to the level of Medicare. The hike was supposed to begin in January but has been delayed as states and the federal government work through a complicated administrative process. California officials say that once the increase begins, doctors will be paid retroactively.
Some doctors say the increased pay may lure them back to Medi-Cal. Others worry their practices are too packed for more patients, regardless of the pay.
The result is more of the uncertainty that makes it impossible to define what will happen when newly insured patients try to get care.
"What's true now may not be true in six months," said Dr. Margaret Cheadle, a Simi Valley family-practice doctor. "We're all figuring this out together."
A study from UC Berkeley and UCLA suggests federal health care reform in Ventura County will mean:
30,000 more people in the Medi-Cal program by 2019.
40,000 to 50,000 people who will be eligible for subsidized health insurance.
60,000 to 70,000 people who will remain uninsured.
Package from Center for Health Reporting on how health care reform changes patients' access to doctors.
___ (c)2013 Ventura County Star (Camarillo, Calif.) Visit Ventura County Star
(Camarillo, Calif.) at www.vcstar.com Distributed by MCT Information Services
[ Back To Technology News's Homepage ]