The People's Health Clinic exists to provide health care to the uninsured in Summit and Wasatch Counties, and with Obamacare implementation, it is adapting to new challenges and acting as a health care navigator, guiding patients toward newly-available insurance options.
The People's Health Clinic has been providing care to the uninsured in Summit and Wasatch Counties since 1998. The organization started out in a van and four years ago moved into the spacious, modern quarters it now leases in the Summit County Health Department building at Quinn's Junction in Park City. People's Health Clinic has a 40-year lease, at $1 per year, to continue operating out of that location. That space includes designated rooms for dental and prenatal care. "We have the most prenatal patients of any practice in the two-county area," said Nann Worel, People's Health Clinic's executive director. The rooms are large, in order to handle crowds. "Our patients, because they're so poor, child care is an issue," Worel said. "So sometimes it's a family affair."
Ongoing implementation of the Patient Protection and Affordable Care Act, dubbed "Obamacare," promises to expand insurance opportunities for Utah's uninsured population, and People's Health Clinic is adapting.
"We're partnering with a lot of different agencies to work with our patients," said Worel. "How can we help them look at the exchanges online? One of the assumptions that's made is that everyone has access to a computer. And they don't.
The practical obstacles that People's Health Clinic and its patients deal with continue even after a potential insurance option is found.
"That's only the first step. For example, if we qualify someone for Medicaid, yay, big celebration, but, we need to make sure again that they know where they can go with that Medicaid coverage, what provider is accepting Medicaid, where can they go for their health home so we can transfer their health record over there. So it's not just a matter of saying 'You're qualified, goodbye'," Worel said.
Gov. Gary Herbert is currently deliberating about Medicaid expansion in Utah. Medicaid is the main government program that provides health care to the poor and Obamacare includes a large Medicaid expansion. It includes 100 percent federal funding to states for the first three years of expansion, eventually being phased down to 90 percent in 2023 and beyond. Other than some mandatory reforms, it is up to each state to decide how much to expand. Expanding Medicaid coverage in Utah would provide greater coverage to its population, but would eventually cost the state more annually. The deliberations include many factors, including job creation, economic impact and the capacity of the current health care workforce.
At the governor's annual health summit on Sept. 26, the Utah Department of Health presented five Medicaid expansion options for Utah. The five options include taking no actions beyond the minimum required of states by Obamacare, full Medicaid expansion and a couple of costlier "partial optional expansion" choices.
Currently, Medicaid is not available to childless Utahns under 65 and who are not pregnant or disabled. It is also not available to those with children who earn more than 50 percent of the Federal Poverty Level. Full expansion under Obamacare would result in Medicaid being made available to all Utahns earning up to 138 percent of the federal poverty level.
The federal poverty level varies by year and by family size. For the 48 contiguous states in 2013, the individual level is $11,490. For a family of three it is $19,530.
The repercussions of the governor's decision will be significant. At one end of the potential paths is the mandatory-only option. It would increase Medicaid enrollment by 60,202, increase Medicaid administration costs to the state by $221 million, generate $39 million in state and county taxes, generate $554 million in economic impact to Utah and create 802 new jobs over the next 10 years, according to the Utah Department of Health's analysis.
On the flip side is the full expansion option. The Department of Health forecasted that full expansion would increase Medicaid enrollment by 123,584, increase Medicaid administration costs to the state by $260 million, generate $203 million in state and county taxes, generate $2.9 billion in economic impact and create 4,160 new jobs over the next 10 years. In addition, the projection notes "hospitals and community health centers would save $814 million in uncompensated care."
The full expansion option is actually two options: one with full Medicaid benefits and one with lesser "benchmark benefits". The Department of Health's report makes a more detailed and stronger case for the benchmark benefit option, perhaps because it is more feasible, politically.
Republican legislators are opposed to full Medicaid expansion. In fact, that opposition is cited in the Department of Health's report as a "challenge" to full expansion implementation. Medicaid implementation across the country has varied, with many Republican governors declining to fully expand their Medicaid programs.
Park City Medical Center is a key partner for People's Health Clinic and together provided approximately $2 million in charitable care last year. Park City Medical Center CEO Robert Allen is closely following Obamacare implementation in Utah and does not envy the governor's current position.
"The governor has a tough decision," Allen said. "When you expand coverage, you would expect an increase in volume of service initially, just because people who didn't feel like they had access to certain services now feel like they do.
"When you're talking wellness, that's a good thing," he continued. "On the flip side, the challenge we sometimes see with a population like the Medicaid population, which is an at-risk population, is that they might delay care for a long time and have more severe things develop because they didn't get treated early. And so the access point here is a good thing, but managing that in an effective way is the real challenge."
Allen noted that if Medicaid is fully expanded, there could be a potential 400,000 Utahns who qualify. As is the current case, however, not everyone who is qualified will sign up, for varying reasons. There are currently tens of thousands of Utahns who qualify for Medicaid but are not enrolled.
For People's Health Clinic, full Medicaid expansion would not mean that its services will no longer be needed (universal health care it is not) and there are plenty who will fall through the cracks, including undocumented immigrants and legal, documented immigrants who have lived fewer than five years in the United States.
"If a patient is eligible for a service such as Medicaid, that's where we want them to be," Worel said. "We truly are the safety net. So when people have no other option, that's why we're here - to take care of those folks."