Local policy, health administrators weigh in on health care bill
Community clinics could get more funding, questions remain about supply and demand
Luisa Buada breathed a sigh of relief Tuesday after federal health care legislation was signed by President Barack Obama.
As CEO of Ravenswood Family Health Center in East Palo Alto, Buada witnesses first hand how a lack of health insurance affects her clients, many of whom avoid seeing a doctor until they are seriously ill or develop chronic diseases, she said.
But the health bill's passage is also of personal significance for Buada. Her 18-year-old son has pre-existing conditions that she feared would make him ineligible for insurance under her policy unless he went to college, she said.
"I was praying for the bill to pass," she said.
The bill could be life-changing for many of Ravenswood's patients, according to Buada. For starters, the preventive care they will receive will help lower health costs in the long term.
Then, once people get insurance (which won't happen until 2014) patients will start taking care of medical issues before they become serious. Uninsured patients often wait until they are sick enough to go to a hospital for care, costing the system more money, Buada said.
In 2014, a pool of insurance plans will kick in to allow a range of coverage from "catastrophic to Cadillac," she said.
Having more options for insurance will improve the quality of life for many by ensuring they are covered for certain illnesses, she said.
Samima Hasan, CEO of the MayView Community Health Center, which has a clinic in Palo Alto, said patients who have been denied coverage due to pre-existing health conditions could qualify for the new high-risk pools to be set up within 90 days.
Starting in six months, two additional features of the bill could insure people who have lost insurance and currently have MayView as their only affordable option for health care, according to Hasan.
"Children can be covered under their parents' policy until they are 26 and children with existing health problems cannot be denied coverage," she said.
In 2011, new funding will help community health centers provide basic care for low-income and uninsured people.
If MayView qualifies, it could then receive enhanced Medicare and Medicaid reimbursements, purchase prescription and non-prescription medications for outpatients at reduced cost through the federal drug-pricing program and add personnel from National Health Service Corps, among other benefits.
Buada is concerned about the impact of newly insured patients on the current infrastructure of medical care. San Mateo County has 5,000 patients in need of a primary care physician and currently there are not enough doctors, she said. Ravenswood has limited capacity for 1,000 patients at its Belle Haven clinic in Menlo Park but no room at its East Palo Alto facility, she said.
Under the current system many doctors chose specialties rather than internal medicine because the reimbursement rate was better, she said.
But the health care bill could change that trend. Doctors, nurses and dentists who choose a career in primary care and participate in a community clinic will be eligible to have their federal loans paid off through the National Health Service Corps.
"It will make a huge difference in areas that are less desirable for people to work in," she said.
Emily Lam, Silicon Valley Leadership Group senior director of health care and federal issues, is also concerned about having enough doctors to meet the demand.
"Are we ready to handle the load?" she asked.
"There are 8.2 million uninsured Californians. We've been under-investing in clinics. ... There is money in the bill to encourage primary care physicians, and they should get paid more and see an increase in reimbursements. But how fast are we absorbing the 8.2 million people and producing primary care physicians?" she said.
Lam said one big benefit of the bill could be that patients won't be cut off from insurance payments in the middle of their therapy, benefiting many with cancer and chronic diseases.
The bill has money for preventive and wellness care, which will hopefully bring down the cost of medical care in the coming years and that could make significant changes in the health of community clinic patients, she said.
Lam said a fundamental question regarding the health care package is whether costs for the whole health care system can be kept down. But people whose concerns about the bill revolve around "costs, costs, costs" are missing the big picture, she said.
"It has nothing to do with the bill. It's the dysfunctionality of the system. ... If we can't bend the curve of high health costs, we're still in trouble. Irrespective of the bill, private insurance is on a crash course unless we keep costs down," she said.
Paying doctors for preventative care — helping patients address diet and lifestyle issues that could lead to chronic disease — will be crucial, she said.
In the future, she predicts "accountable care organizations" that address those issues will be as ubiquitous as health-maintenance organizations.
Lam said regardless of the challenges, she considers the health care bill "a huge victory" for the 32 million Americans who will get insurance.
"This is it. It finally came. People want to debate, 'Is this bill good or bad?' My entire career I've been waiting for this moment for us to step forward. The devil is in the details. Whether we see something come out of it depends on what we as policy makers put into it.
"The bill is not inherently bad. It's only bad if policy makers don't get involved in who gets what, when, why they get it — all the nitty gritty," she said.
Staff Writer Sue Dremann can be e-mailed at firstname.lastname@example.org.