Inland community clinics gear up for state rollout
By Chris Levister
With the re-election of President Barack Obama, the Affordable Care Act, passed in 2010, stands as a historic achievement, ending a decades-long quest by Democrats — and some Republicans — to guarantee healthcare to all Americans.
That outcome — which seemed almost unimaginable this spring when the Supreme Court considered whether the Affordable Care Act was constitutional — puts immediate pressure on many Republican state leaders who fought it. They must decide in days whether to implement it or have the federal government do it for them.
“It's all over but the shouting," said Families USA Executive Director Ron Pollack, a consumer advocate and leading champion of the law. "What was very questionable at the start of the year has been settled. … The Affordable Care Act will be a permanent fixture of the American healthcare system.”
The election results, also present Obama with a new set of challenges as he tries to fulfill the promise of his signature legislative achievement, the biggest expansion of the social safety net since Medicare and Medicaid were created in 1965.
California was the first state in the nation to pass legislation creating a health insurance exchange after the enactment of federal health reform.
Its place assured alongside Medicare and Medicaid, Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, called the Affordable Care Act the most significant piece of social legislation in half a century.
“We’re now in a sprint to the finish line, with 11 months to go before millions of uninsured people can start signing up for coverage,” says Lindsey whose growing network of Inland federally funded health centers provides medical care to about 12,000 San Bernardino and Riverside County residents, many of them low income.
Under the law, millions of Americans should be able to get health insurance for the first time starting in 2014. Millions more who don't get coverage through work should be able to buy a health plan that meets new basic standards.
“We are speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians,” Ms. Lindsey said, estimating that Inland clinics would see new demand from 10,000 to 25,000 residents by 2014.
Although the Affordable Care Act, passed in 2010, won’t be fully in place until 2014 billions of dollars have already been distributed and the wheels of reform have begun to turn.
Lindsey says federally funded community clinics like this one on North E Street in San Bernardino are booming, in California and across the country. They are expanding and renovating with billions in federal dollars provided by the stimulus legislation and the Affordable Care Act.
Although the neighborhood feels troubled, on the inside, this superstore-sized clinic is stocked with clean exam rooms, a pharmacy and a seven-chair dental wing. It also offers psychology, radiology, vision and even housing services.
This clinic is part of a Federally Qualified Health Center (FQHC), a type of clinic targeted in President Obama’s health reform measure as a key component in building medical capacity for the millions of Americans expected to gain health insurance under the legislation.
In California, there are about 120 FQHCs, representing over 1,100 “delivery sites” and serving upwards of 2.9 million patients. Nationwide, there are more than 1,100 FQHCs providing care to about 20 million patients at 8,000 delivery sites.
The clinics use the federal money to build more centers, add more exam rooms, expand services and switch over to electronic health records. As a result, many of these clinics are no longer operating on shoestring budgets.
Over the last two years Inland Behavioral and Health Services has expanded its reach in to Banning and is using federal grants to renovate and expand its existing centers in San Bernardino County.
“There’s also a special reimbursement that we get for each patient that has Medicare or Medi-Cal that exceeds what a doctor in private care would get,” said Lindsey.
This higher reimbursement allows clinics to build a team-based approach, or patient centered medical home emphasized under the Affordable Care Act. Under this model, patients see teams of caregivers from chronic disease specialists to social workers to nutritionists to clinical pharmacists.
Seniors with Medicare prescription drug coverage are getting cash rebates. Young adults have joined their parents’ insurance policies. Uninsured Americans with pre-existing conditions are getting health coverage through Affordable Care programs.
An added benefit, Lindsey said, is that the team approach allows primary care doctors to focus on prevention, wellness and public health.
More than 30 insurers, including Kaiser and Health Net, are expected to seek a spot in the state's health insurance exchange now called Covered California.
California's health insurance exchange said more than 30 plans are expected to vie with one another for spots in the state-run marketplace opening next fall.
State officials, and those in other states, are eager to flex their purchasing power under the federal healthcare law by selecting only certain individual and small-business health plans for 19 different regions across California.
The exchange, branded as Covered California, will negotiate with insurers for the best rates and will assist consumers and small businesses in choosing a plan by separating them into five categories based on cost and level of benefits.
"There will be a lot of competition and interest, which will enable the exchange to be an active purchaser in every region and pick the best five or six plans," said Peter Lee, executive director of the California exchange.
Despite the Affordable Care Act’s more certain future under an Obama second term, controversy over the law isn’t over. The public is still largely split on its merits. Republican state lawmakers and governors won’t suddenly and universally back the law. Republicans in Congress still have say over funding for some of its programs.
But the health care industry is now free from a great deal of uncertainty. Or at least it’s free from this round of uncertainty.
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