State has Healthy Jump on Affordable Care
Kristen V. Brown
August 27, 2013
San Francisco Chronicle
For years after Rachelle Hammond was diagnosed with COPD - chronic obstructive pulmonary disease - her routine treatment strategy was a visit to the emergency room.
Hammond, 54, was uninsured and could not afford the necessary medications or regular trips to a doctor's office. So when the disease got so bad that she "couldn't breathe," she would head to the ER at a local public hospital in Arkansas, where she then lived. That happened, she said, about once or twice a month.
Last year, Hammond moved to San Leandro. In California, she was not eligible for Medi-Cal, but she did qualify for the Health Program of Alameda County, or HealthPac.
The program is Alameda County's iteration of the Low Income Health Program, a statewide initiative that has provided more than 500,000 low-income state residents with health care.
The initiative was conceived with the federal Affordable Care Act in mind and is often referred to as a "head start" to the health reform law because it is enrolling uninsured people ahead of it.
"The pump has been primed in California for more than half a million people, and as a result we don't expect this big bulge of people who are newly insured when the (federal) law goes into effect," said Gerald Kominski, a health policy professor at UCLA.
The new federal health law kicks in on Jan. 1, when most Americans will be required to purchase health insurance. Beginning in January, Medi-Cal, California's version of Medicare, will expand under the new federal law to include many more low-income Californians, Hammond included.
Since 2011, however, some California counties, including Alameda, have offered health care to a large chunk of those people.
To be eligible for Alameda's program, a person must be a resident of the county, not eligible for Medi-Cal, and have a gross monthly income at or below 200 percent of the federal poverty level. Income qualifications vary across counties.
Coverage is not as extensive as what most insurance policies or Medi-Cal offer, but those enrolled in Alameda receive a range of basic health services, including checkups and care for chronic conditions. Co-payments are determined by income.
The goal is essentially to get enrollees to seek out regular medical care, rather than emergency services, which can be costly for local governments.
The benefits, said Dr. Kathleen Clanon, medical director of Alameda County's program and Associate Chief Medical Officer of Alameda Health System, are twofold. The programs deliver health care coverage to hundreds of thousands of otherwise uninsured state residents and counties have gradually revved up to serve the expanded patient population expected come January.
In Alameda, as in many counties, participating health institutions had to accommodate the growing influx of patients by improving communications and electronic record keeping, as well as hiring new doctors and other staff.
'Bridge to Reform'
Approved in 2010 as part of the state's "Bridge to Reform" Medicaid waiver, the locally funded, federally reimbursed programs have enrolled more than 500,000 Californians in advance of the new federal law. All told, 19 programs have been established to cover 53 of the state's 58 counties.
Alameda County's program, which provides health care through a network that includes the Alameda Health System and several community-based primary care organizations, has provided coverage to more than 49,000 of an estimated 52,000 people that will be eligible for services in January, according to a report issued last month by UCLA.
In January, those who earn up to 138 percent of the federal poverty level and qualify for the Medi-Cal expansion - the vast majority - will be automatically rolled over. The minority of people who do not qualify will be eligible for subsidies through the state insurance exchange.
Hammond, the San Leandro resident, visits the COPD clinic at Alameda Health System's Eastmont Wellness Center every Monday, where she is assessed by a doctor and has access to a respiratory therapist, nurse and pharmacist who teach her about how to take care of her illness.
She also has access to a 24-hour nurse that she can phone any time, as well as transportation services that get her to her appointment.
Care improves health
A former longtime smoker, Hammond suffers from chronic coughing and fatigue as well as frequent breathlessness and respiratory infections. She doesn't work, and said she was ineligible for Medi-Cal because she no longer has children living at home.
Her health is still troublesome - she says she has been hospitalized twice in the past year. Still, her health has improved thanks to regular care and access to medication.
"With my health, I'm sitting in the best spot I can sit in for right now," she said.
Kristen V. Brown is a San Francisco Chronicle staff writer.