Health care field awaits another seismic shift
As a mother checked in at the front desk of a south Oklahoma City health clinic, her two young boys made laps around her as they chased one another. With one hand she wrote her name on the sign-in sheet and with her other she grabbed the eldest boy by his shirt collar in an attempt to put an end to the horseplay.
Behind the mother was a young couple, the father rocking his crying infant who gasped for air between each scream. Behind them another family walked through the front doors as the clinic’s lobby quickly filled up.
The Straka Terrace clinic serves between 15,000 and 20,000 patients annually. Operated by Variety Care, the clinic is the largest in the community health center’s network of 12 sites in Oklahoma.
Primary care, women’s health, pediatrics, dental, vision and behavioral health are all services offered on site to patients of any financial means, especially those who lack insurance or cannot afford services at another medical facility.
The clinic also includes a pharmacy
where Leticia Romero said she can purchase medicine for $3 less than at the nearby Walgreens.
“Three dollars is three dollars,” said Romero, who is a single mother without health insurance.
America’s health care sector saw substantial change under President Barack Obama and appears destined for another major adjustment when Donald Trump becomes president on Friday.
A Republican Congress has vowed to repeal the Affordable Care Act, one of the defining acts of Obama’s presidency that expanded health insurance to millions. While repeal would seem an easy process for the Republican majority, a replacement plan has yet to be defined.
Insurance coverage
Trump vowed in an interview last week with The Washington Post his new health care plan would mean “insurance for everybody.” But for patients and health care providers there remains much uncertainty about what’s to come.
“Some type of funding is going to be needed ... if you want to insure everyone,” said Myra Guzman, a medical support team leader at the Straka Terrace clinic. “Even through the (Affordable Care Act) ... some things are still expensive. If you are applying for the Affordable Care Act you are thinking it’s going to be lower than a commercial insurance plan, but many are finding that it’s not.”
Some of the clinic’s patients have traditional health insurance or a plan offered through exchanges subsidized by the Affordable Care Act, also known as Obamacare.
But most of the patients fall into what’s often called the “coverage gap,” meaning they earn too much to be eligible for a federal insurance subsidy, but can’t afford a traditional insurance plan.
Patients at the Straka Terrace clinic are put on a payment plan based on income level. It’s a system that has a nearly 95 percent repayment rate, clinic staff said.
Beyond insurance
Lou Carmichael, Variety Care’s executive director, said a larger insurance pool is necessary to retain coverage of pre-existing conditions and other aspects of the ACA. But she also believes the incoming president should consider how a quality health care plan goes beyond insurance.
“When we talk about health care reform, so often we talk about insurance and we get stuck on the coverage piece,” Carmichael said. “But really, the Affordable Care Act, and I think any policy that is going to have any ability to change things, is going to have to decrease cost, increase outcomes and improve patient engagement in their own health.”
Access to insurance remains a challenge for many low-income Americans, but Carmichael said other barriers include transportation, language and health literacy.
Sitting in a dental chair a young woman listens as a dentist offers options for replacing a decaying tooth. As soon as the dentist stops talking, the young woman turns to a translator who explains in Spanish that a crown could be her best option.
Language can be a barrier to health care, especially in parts of the state like south Oklahoma City where the Hispanic population continues to grow.
“Many of our patients come here because this is a place they can communicate with doctors and staff,” said Annalee Velasco, a front office team leader at the clinic where many staff members are bilingual. “You can’t find that everywhere.”
But beyond language, a lack of personal health knowledge can cause problems, Carmichael said.
“That’s a piece of the puzzle here, getting people to be really engaged in their health,” Carmichael said.
Variety Care also pushes for individuals and families to have primary care physicians, doctors who provide regular checkups and can address health issues before they become major issues.
“Primary care has to be a focus of whatever we do with health care reform,” Carmichael said. “We need to be looking at ways to expand that.”
Most people will visit a doctor or hospital when suffering from a severe illness or injury, but access to a primary doctor can help address preventive issues, such as heart disease or diabetes, Carmichael said.
Getting more individuals on insurance plans could help achieve that goal.
“A person can always go to the doctor, but a person with insurance feels more motivation to go,” Velasco said. “When someone knows they are covered for something ... they will get it looked at.”
But cost remains the primary issue for many when it comes to accessing health care.
“I would have to work many more hours,” Romero said about affording insurance or paying for a visit to a more expensive clinic.
Romero said she values her health, but it’s not uncommon for people to weigh their health needs against their financial limitations, a reality she hopes the new president and Congress will remember when making decisions about health care funding and policy.
“You want to seek the best (health care) but also be economical,” Romero said. “Everyone is seeking what’s best for them.”