Clinics Wait For More Patients in Obamacare Wake

April 14, 2014

File photo/Getty Images

File photo/Getty Images

By Genevieve Bookwalter

St. James Health Center is ready for the onslaught.

The community health clinic, one of the busiest in San Jose, sits on the corner of 2nd and Julian streets near downtown. Doctors, dentists, pharmacists and other health-care providers here treat some of the poorest patients in Santa Clara County — patients whom many expect to have newly-minted health insurance this year as the federal Affordable Care Act kicks in.

But the clinic has, unexpectedly, not seen an increase in demand for primary-care physicians, whom the newly insured were expected to tap to finally treat ongoing aches and pains.

Instead, doctors here continue to see about the same number of patients — 55,000 each year — and 35 percent of those are uninsured or underinsured. That’s because more than one-third of the patients who visit the clinic are undocumented immigrants, according to official estimates. These patients are not able to receive insurance under the Affordable Care Act.

“It’s very clear in the language that you have to be a U.S. citizen, have a green card or a working visa,” said Constance Tucker, chief medical officer for Gardner Family Health Network, which oversees a group of affordable medical clinics in Santa Clara and San Mateo counties. “You can’t get past it.”

Gardner employed outreach workers to sign up uninsured patients for Covered California, the state exchange for residents who need insurance under the Affordable Care Act, Tucker said. Only 1 to 2 percent of the few thousand screened were eligible.

“We were hoping to have more of an impact, but it hasn’t come to fruition for us,” Tucker said.

The federal Affordable Care Act was passed in 2010 and takes effect this year. Under the new rules, all U.S. citizens and those in the country legally are eligible for insurance coverage. Those who qualify and are not covered will face penalties.

Some teens and young adults who emigrated illegally to the U.S. as children are also eligible for health coverage in California. They must first be accepted into the federal Deferred Action for Childhood Arrivals program.

The deadline to begin signing up for insurance under Covered California was March 31. The deadline to complete applications is April 15.

Attracting the newly insured is important, Gardner officials said, because their coverage helps pay for treatment for those who can’t afford health insurance or pay for treatment on their own.

Despite the lack of an early rush to see doctors, officials said it’s too early to draw conclusions about Covered California’s effect on patient numbers.

For example, a jump in the number of patients might not happen for a few months, as many still are waiting for their registration packets and insurance cards to arrive in the mail, Tucker said.

In addition, most new patients won’t drop everything and come in immediately after receiving insurance, Tucker said. Many might not stop by until the next flu season.

Meanwhile, Garner has invested over the last few years in the facilities needed to treat more patients.

One South County clinic has expanded, Tucker said, while a new clinic for children just opened in San Mateo County. Other clinics have changed their setups to accommodate more patients and doctors in the same space.

On a recent visit to St. James Health Center, those who qualify for insurance under the Affordable Care Act had varying reactions to the new health-care coverage.

Maria Blackburn, 22, of San Jose, said she signed up for Covered California at the beginning of March and is waiting for her new insurance card to arrive in the mail.

But she doesn’t see herself visiting doctors at St. James more often. Instead, she said, she plans to see doctors at Santa Clara Valley Medical Center, which is run by Santa Clara County and offers more providers and specialists for her to choose from.

“I need more medical care than what Gardner has,” Blackburn said.

Venus Vanaki, 37, of San Jose, said she owns her own business and is still focused on the paperwork as she switches from independent coverage to Covered California.

“For us it’s becoming a hassle,” Vanaki said. “It’s confusing and hard to navigate.”

But if Gardner clinics follow health-care trends elsewhere, they can expect to see a spike in patients — whether they’re the newly insured, aging baby boomers or others seeking care.

At Kaiser Permanente, spokesman Chris Stenrud said expanded coverage under the Affordable Care Act was “one component of many components” as the Oakland-based national health-care provider expands its services across the country.

The “graying of America,” the economy’s anticipated turnaround and other factors all play a part, Stenrud said.

“The ACA is certainly one factor,” he said. “But it’s not a situation where we said, ‘Oh gosh, there’s going to be a huge crush of people, and so we better hire a whole cadre of docs in order to take care of these folks.’”

And while they might not be showing up yet at doctors’ offices, 43,114 Santa Clara County residents had enrolled in Covered California by the end of February, said Joy Alexiou, spokeswoman for Santa Clara Valley Health and Hospital System. That number accounted for 5 percent of the state’s signups, and is expected to swell by the April 15 deadline.

“We feel like it’s right on track,” Alexiou said.

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