Heartland Community Health Center would certainly look a lot different if not for the Affordable Care Act.
A few years ago, the Lawrence practice treated a few thousand uninsured patients a year. But since it became a federally qualified health center under the law known as "Obamacare," it began expanding its capacity by 75 percent and will soon treat a 50-50 mix of clients with and without coverage. But to do so, many of its patients will need to sign up for the low-cost insurance options provided by the health care reform act.
Heartland, like other local providers, is grappling with how to get the word out about the expanded coverage that will be available when the law's online health care exchanges take effect in a little more than four months.
"Whenever you implement a new plan, our first goal is to educate the patient on what the plan does for them," said Tim Bredehoft, staff pharmacist at Lawrence-based Medical Arts Pharmacy, which helped customers enroll in the Medicare Part D prescription-drug program when it started in 2006. "Once we know more about (the new law), we're definitely going to be spreading the word to our patients and beyond."
The Affordable Care Act, passed in 2009, is designed to provide universal health care coverage to all Americans by expanding Medicaid, mandating that citizens have insurance and implementing health care exchanges for consumers to purchase subsidized premiums. More than 18 percent of Douglas County residents, or about 16,000 people, are uninsured.
Still, the public remains widely uninformed about "Obamacare." Recent polls have found that 4 in 10 Americans were unaware it was still a law; 62 percent didn't know tax credits would be available to purchase insurance; and 90 percent had no idea when they could start shopping on the exchanges.
So it's up to providers, insurers and consumer organizations, among others, to ensure Americans make informed decisions when the health care exchanges begin open enrollment Oct. 1.
Kansas health care exchange
• Residents who earn between 100 and 400 percent of the federal poverty level are eligible for subsidies automatically deducted from the price of the insurance, so they spend no more than 2 to 9.5 percent of their income on the premiums.
• Certain small businesses with fewer than 25 employees will be eligible for a 50 percent reduction in their health care costs if their staff purchases coverage through the exchange.
• During open enrollment, from Oct. 1 to March 31, insurers will not be allowed to deny coverage to people with pre-existing conditions or charge women more than men (enrollment is closed from April 1 to fall 2014).
• The plans — offered by Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City and Coventry — will consist of essential health benefits and are said to be more robust than what most insurers currently offer.
• Kansas' exchange is being run by the federal government because the state, like 26 others (most with Republican governors), decided not to create its own.
"A lot of the heavy lifting is going to be done by the government itself," said Robert Lee, a professor of health care economics at Kansas University. "I would anticipate a very significant outreach and publicity campaign that will be starting up probably in September and October. The experience in other places — in Massachusetts and other countries that have done this sort of things — suggests it takes a while for people to understand what's going on and the opportunities available to them."
Lawrence's Health Care Access Clinic will continue to serve patients who fall through the cracks of the system. The practice saw 3,000 uninsured Douglas County residents last year, serving people who fall within 185 percent of the federal poverty level. Executive Director Shelly Wakeman said the clinic won't be impacted by the new law unless the state of Kansas decides to, as the Affordable Care Act calls for, expand Medicaid. In that case, many of Health Care Access' patients would qualify for coverage and move on to other providers. Even then, the law isn't likely to be 100 percent effective, she said.
"We see people who are undocumented. And Medicaid is complicated. People have to recertify — if they don't have the right documents, they get kicked off," Wakeman said.
The Lawrence-Douglas County Health Department likely won't be affected by the exchanges, as it generally provides preventive rather than sick care. Lawrence Memorial Hospital, meanwhile, has yet to announce how it plans to educate patients about the new coverage options.
For its part, Heartland Community Health Center is applying for federal grant funding to hire another full-time employee to provide outreach and screening for the Affordable Care Act. The social worker will assist patients in determining their eligibility for insurance and help patients enroll in the exchanges.
Although the law is unpopular and misunderstood by many Americans, Heartland CEO Jon Stewart says the discussion it created will ultimately be for the greater good.
"I think one of the worst things about the Affordable Care Act is the controversy it stirred up. But I think one of the greatest things about the Affordable Care Act is the controversy it stirred up," he said. "I think if we can get beyond the political part of the conversation and think about what really needs to change in health care, then we can really make some movement. I think it's been a sorely needed conversation in the United States."