By Katie Wildes
The Rockbridge Area Health Center wants to educate uninsured county residents about the Affordable Care Act (ACA) — at a time when the center is serving both insured and uninsured patients.
Nationwide, the ACA has increased the number of people with health insurance by more than 15 million. But many in the Rockbridge area remain uninsured or under-insured, said Justin Skinner, a staff worker in the center’s Outreach Enrollment department.
Skinner became a full-time employee of the Rockbridge Area Health Center when it changed its name from the Free Clinic a year and a half ago. That’s when the center replaced a volunteer medical staff with full-time paid doctors and nurses and began charging patients — in the case of the uninsured, with a sliding scale discount. Another part of the change was adding the outreach staff to educate and enroll residents in health insurance policies, using the “carrot-and-stick” features of the ACA, or Obamacare.
Skinner, the member of this team who meets with residents individually, continues to see a lack of education on the topic of health insurance. In more cases than not, he says, residents do not know what insurance is or how it works, and are intimidated by the many components.
During open enrollment, from November through January, Skinner sets up appointments with those interested in getting insurance. Sometimes they come for information. Other times they come in to register immediately. Some become informed, but never follow up. Each person is given a pamphlet that outlines a step-by-step process for deciding on an efficient plan.
“People either come to the center afraid they will get penalized from taxes or they have heard from friends about getting insurance for a good price,” Skinner said.
The ACA requires citizens to have insurance, or face a penalty of 2 percent of their income, or $325 per person, whichever is lower. Next year that penalty will increase to a 2.5 percent penalty, or $695 per person.
The Rockbridge Area Health Center, after being a free clinic for so long, is having trouble getting the word out to the community of its sliding scale fee system. A portion of patients walk in from hearing about the services. Other times, the counselors of the Outreach Enrollment department go out to spread information and an understanding of the enrollment process. It’s an uphill battle.
Skinner blamed common myths about the Affordable Care Act. Some are not aware that the ACA provides for tax credits for lower-income citizens. Others believe the law will be overturned so they will not be penalized if they remain uninsured.
Transitioning from a free clinic to a health center has been a challenge for the RAHC. The center and its workers are happy with the change, said Janet Beebe, the center’s commutation director. They are covering more people, and are confident in the quality of their medical services. But there is a struggle to bring in enough income.
The federal Medicare and Medicaid programs, local businesses, foundation grants and other agencies contribute a portion of the revenue, but the costs of running the growing center is not fully covered. The center’s write-offs for sliding-scale patient adjustments are running around $60,000 a month, said Kelly Balthaser, the outreach and enrollment supervisor.
Since changing its business model, the center has been able to develop full-time paid medical staff, instead of volunteers, and add including the Outreach Enrollment staff.
These outreach employees have been working to decrease the number of uninsured in the Rockbridge area, previously reported at 62 percent. The center seeks to serve a full range of patients, from those who can fully afford the services to those who need sliding scale fees.
“We still have a significant population who, in some states, would be covered by Medicaid, but here are not,” said Jane Horton, who chairs the center’s board. “The ways we are continuing to provide the services that we provide as we did as a free clinic are by opening up our services to everyone and hoping that people with insurance coverage will help our operations.”
A problem is the ages Medicare and Medicaid support. Some couples have one person older than 65, while the other is younger, mandating them to be on separate plans, paying different amounts.
These days, between open enrollment periods, the coordinators have been focusing on an ACA program called SHOP, Small Business Health Options Program, for businesses that have to provide insurance coverage for the first time.
Skinner says they have not seen much success with small businesses in the Rockbridge area. But they are continuing to focus most heavily on individuals and families, providing insurance and good medical care for everyone, he said.