Back in March, when we first reported on the Affordable Care Act's impacts on several individuals and providers in Humboldt County, we came away with a mixed picture of relief and frustration ("Faces of Obamacare," March 6, 2014). Some folks were able to get health insurance after being previously denied or unable to afford it, while others were able to drop an expensive plan for a cheaper one. So that was good. But then some of them quickly discovered that their new insurance under Covered California wasn't accepted by most local providers — except those at Open Door Community Health Centers. And Open Door was preparing for an onslaught of new patients.
We followed up with these patients and providers this month to find out how they've fared since.
The Affordable Care Act's been good to Jude Ehrlich, 45, of McKinleyville, who was born deaf and has other health issues. It enabled him first to drop his federal Pre-Existing Condition Insurance Plan with its $300-a-month premium and scanty coverage, and get free coverage under Medi-Cal once its eligibility qualifications were expanded. Later, Ehrlich, who'd been struggling to keep his computer repair business afloat, got a part-time job at the Area 1 Agency on Aging, and he no longer qualified for Medi-Cal. No problem, he said.
"I had to register on Covered California and find something else that would cover me for a reasonable cost," Ehrlich said. "I now have Anthem Blue Cross. It costs about $100 a month, it is a PPO, it covers 70 percent of costs and I am responsible for 30 percent of costs."
He said the member services department at Open Door Community Health Centers helped him find the right plan.
When last we spoke with Charles Minton, his wife was in a plan-juggling limbo. She had enrolled with Anthem Blue Cross under Covered California, thinking to replace her existing $15,000-deductible, catastrophic health plan with a cheaper plan with more services. But then, like so many others, she couldn't find a provider who would accept her new state insurance. So Minton said he and his wife decided she should hang onto both plans and hope for something to budge. Well, it did: Her provider finally became an in-network carrier of her Covered California plan with Anthem Blue Cross, so that's the plan she stuck with.
"Things have gotten a lot better," said Minton.
Casey Schuetzle, who's self-employed, signed up for Covered California with great expectations. She'd been uninsured about five years since losing coverage under her parents' plan, and the new state plan covered her primary care at Open Door (which was the only local provider accepting Covered California at first) and lowered her prescription costs. But what the 30-year-old surfer from Manila had really been counting on was being able to get her bum shoulder fixed — and no surgeon would accept her insurance. But, she reports, she finally found a surgeon at UCSF and had shoulder surgery last July.
"I've surfed twice," she wrote in an email last week.
And she's been able to do all of her physical therapy locally.
"My feelings toward Covered California are more positive now that the network has expanded locally. ... I partially attribute that to the fact that I feel better, and when you feel better you can handle setbacks a little better."
COMMUNITY HEALTH CENTERS
Open Door Community Health Centers' policy, as the name implies, is to take everyone who walks in the door. Uninsured patients pay on a sliding scale, from nothing on up. So, with Covered California, Open Door was looking at its finances improving as previously uninsured patients acquired new state health plans. And the fact that Open Door was just about the only outfit in Humboldt accepting Covered California at first — and that it's the only certified walk-in Covered California enrollment entity in Humboldt, with counselors on-hand to help patients find the right insurance coverage — promised an onslaught of new patients.
"We have experienced increased demand at all of our clinics," said Brea Olmstead, Open Door's director of member services in the enrollment department. "We've heard from many patients who never had insurance ... and from patients who previously had been a patient at a private practice that's not taking Covered California plans."
In the last three years, she said, the nonprofit's uncompensated care decreased by half: from 17 percent of patients agencywide having no insurance in January 2012, to 9 percent at the end of 2014.
In this most recent enrollment period, beginning Nov. 15, 2014, and ending Feb. 15, as of last week Open Door had submitted applications for 750 families seeking either Medi-Cal or Covered California coverage.
The nonprofit's increased patient load isn't just the result of Obamacare; since last spring, Open Door has partnered with several private practices in the Eel River Valley whose providers were retiring.
"The plan is to beef up the staff," said Olmstead, to accommodate new patients in all of its clinics. But she emphasized that Open Door doesn't turn anyone away. In some cases a person might have to wait for an appointment. But cases needing immediate attention will get in quickly.
EUREKA FAMILY PRACTICE
When Covered California first rolled out in late 2013, its major insurers locally, Anthem Blue Cross and Blue Shield, were offering such dismally low reimbursements rates — as much as 65 percent less than they'd pay providers under traditional insurance plans — that most private practices had to reject their plans. Last spring, Eureka Family Practice was still struggling with the fallout, having had a number of its long-time patients switch to Covered California and discover to their dismay that their provider couldn't accept their new state insurance. And EFP had to turn away prospective new patients, suddenly insured, for the same reason.
"We really wanted to be in-network," said EFP's billing manager, Catherine Markle. "We weren't trying to turn our nose up."
By May, however, Anthem had come back to the table, Markle said, and agreed to offer better reimbursement rates. So now EFP is in-network with Blue Cross and Blue Shield plans with Covered California. (It is not accepting Medi-Cal, however.)
"It's really been easygoing" ever since, said Markle. Although, she added, the practice is constantly recruiting for more providers to keep up with an influx of patients. "We're being flooded with new patients."
Mostly that's because a number of providers in the area have retired recently, and Humboldt already had a chronic provider shortage. Covered California just made things harder, Markle said, adding that "the only physician on staff accepting new patients is booked out into May."