Clinics scale back over health law worries
For most of last year, Sherry Hirota, chief executive of Asian Health Services, was planning to convert two floors of offices in its Oakland Chinatown facility to clinic space to accommodate more patients.
But that changed on Nov. 8. Soon after the election — as Republicans in Congress began taking steps to repeal the Affordable Care Act — uncertainty over the future of the health care law forced Hirota’s group to scale back those plans. They are now going to build out just one floor of new clinic space instead.
That’s because Asian Health Services stands to lose $8 million, about 15 percent of its annual revenue, if the Affordable Care Act is repealed without a comparable replacement.
Hirota estimates that a third of the clinic’s patients, roughly 9,000 people, would lose the insurance they gained under the health law’s Medicaid expansion and federal subsidies — making it more difficult for the community health service to collect payment for medical services.
“It couldn’t come at a worse time because we have a big backlog of patients who need to be seen,” said Hirota, whose organization provides primary care to low-income, non-English-speaking residents.
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“It couldn’t come at a worse time because we have a big backlog of patients who need to be seen.” Sherry Hirota, CEO of Asian Health Services
to repeal the law, but have not come up with a replacement — is forcing health providers across the Bay Area to rethink decisions about budgets, staffing and patient treatment.
In California, the Affordable Care Act mostly plays out through two programs: Covered California, the health exchange where people can buy private insurance with the help of federal subsidies; and the expansion of Medi-Cal, California’s joint federalstate Medicaid program for seniors, people with disabilities and lowincome adults.
In sheer numbers alone, the expansion of Medi-Cal has been much more dramatic, adding 3.8 million Californians since the law took effect in January 2014. In comparison, 1.4 million people get insurance through Covered California.
When the law took effect, clinics like Asian Health Services began seeing an influx of newly insured patients who started visiting doctors more regularly. Many clinics hired physicians, nurse practitioners and support staff to keep up with the demand. Now, they are grappling with how to continue serving those patients without the promise of additional federal funding.
“Significant dollars come to us through that Medi-Cal expansion population,” said Marty Lynch, executive director of Lifelong Medical Center, an East Bay nonprofit that treats 53,000 patients a year. “If that were to go away, clearly we’d have to take steps to adapt. Undoubtedly, it would mean fewer services and fewer staff. There’s no question about that.”
La Clinica de la Raza, an Oakland community health center, saw a 25 percent drop in uninsured patients after the Medi-Cal expansion, said chief executive Jane Garcia. The clinic serves about 90,000 patients each year, 95 percent of whom are either on Medi-Cal or have no insurance.
The additional dollars the clinic received as a result of the Affordable Care Act have helped it improve the way it manages the handoff of patients from hospitals, such as better coordinating follow-up appointments and medications, Garcia said. She is concerned that progress will be disrupted.
“If you’re taking money out of the system, being able to do the same things is going to get compromised,” Garcia said. “We were starting to build that infrastructure, and I’m very concerned about what happens to that progress.”