‘I don’t want to be part of the welfare system’: The problem of Obamacare enrollment

July 12, 2013

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.


Mary's Center president Maria Gomez (Mary's Center)

The Obama administration distributed $150 million in health law outreach and enrollment grants to 1,159 community health centers across the country. One of the biggest grants went to Mary's Center, a federally-qualified health clinic that serves the District and Maryland, in Montgomery and Prince Georges County. The clinic received just over $170,000 from the federal grant, and also has separate funding from the state of Maryland. 

I spoke with Mary's Center president Maria Gomez Thursday about what the new funding means, how it will be used and the biggest challenges she sees with the Affordable Care Act. What follows is a transcript of our discussion, lightly edited for clarity.

Sarah Kliff: Tell me a bit about the people that Mary's Center serves right now. Who are your patients?

Maria Gomez: A large majority of our population, and one reason we got one of the largest grants, is because we have a really high proportion of people who are uninsured. The question is now, how much work can we do to make sure that we enroll as many people as we can? We know that, for over 90 percent of the uninsured we see now, they're not currently eligible for insurance, either because of their immigration status or they're slightly over the income limit.

That's our population. And there's this tremendous amount of outreach that we're going to have to do, to go out to businesses and try to get people really more or less educated. All of us are in the health care field, and we're still learning. If someone is running a restaurant, they probably haven't even had time to think about this.

SK: What proportion of the population you serve right now lacks health insurance?

MG: In Maryland's Montgomery County, we have just over 60 percent uninsured. In Prince George's, it's 80 percent who are uninsured and in the District its less than 20 percent. The reason for that is because Montgomery County and the District both fund a large portion of care.

SK: So how do you begin to start thinking about reaching these people? What does your outreach plan look like?

MG: One of the things that we're going to have to do very soon is get our employees signed up. We have employees who make between $25,000 and $40,000 who need to be instructed about what this is all about. Some of them don't take insurance right now because we pay 70 percent of the costs, and they have to pay 30 percent. Because insurance skyrocketed this year, 30 percent is a big amount, especially if you need to take the family plan. I think that there will be a number of people who will not choose to do this initially, and that's where our eligibility work will be important.

SK: And how specifically are you going to be spending the new funds that you're getting?

MG: Between the federal grant and the state grant from Maryland, we think we're going to be able to hire a total of seven people. A lot of what they'll be doing, hopefully, is being out talking, being on the radio and going to churches and associations. They'll be going to health fairs and then educating this whole new population that I am very concerned about. For a lack of a better way to say it, a lot have never been interested in taking any public services. We're going to have to say to them now, "You have this opportunity to come into the public system." They're going to be like, "I don't want to be part of the welfare system."

SK: So how do you tackle that kind of attitude? What kind of work can you and your staff do to change that?

MG: It's very hard. You think, if you're getting health insurance, why would people fight it? But then you have to go through the system, apply to the Medicaid office and they might not be used to.

I think one way we're going to change that attitude is talk about taxes going up. And depending on where our patients live, they might be getting very little for it. Their schools may not be the best. The infrastructure and highways are not the best. So here is something you can actually get back, from the amount of taxes you put in. You owe it to yourself and your children to stay healthy, especially for people who will get a tax break. Hopefully that whole idea will bring people into the system.

SK: I know that federally-qualified health centers have traditionally been the safety net, where many of the uninsured go. Do you think they'll come back once they gain coverage?

MG: We have been the safety net for all these years. What's happening now is that people will get enrolled and then everybody wants to get into the business of health care. We've been here 25 years serving this population. When they come into our center, they maybe haven't seen a doctor, but we're also hooking them up with social workers. We make sure if there's mental health issues, we take care of that.

Primary care is not going to be able to do that. So what I'm afraid is that this influx will come in to primary care offices, and then they'll drop that population when they realize they're not making money.

KLIFF NOTES: Top health policy reads from around the Web.

Hospitals are pushing doctors to improve, using big data. "Marnie Baker, a pediatrician at California's MemorialCare Health System, has an easy manner and ready smile. Now, though, her job is to be the bearer of a serious and, for some of her colleagues, unwelcome message. She's the voice of a program that digitally tracks their performance, informs them when they don't measure up—and cajoles them to improve." Anna Wilde Mathews in the Wall Street Journal.

Obama campaign alums are getting started on Obamacare outreach in Florida. "Jimmy Tan, the organizer responsible for reaching out to residents in Miami-Dade County — Enroll America's most critical Florida region — is a veteran of Obama's 2012 Organizing for America campaign in Florida. Tan's staff of seven were chosen for their grassroots organizing experience in targeted Hispanic and Haitian neighborhoods, where they’ll be recruiting volunteers and partner organizations to help spread the word." Patricia Borns in the Miami Herald

Walgreens and Blue Cross Blue Shield Administration are teaming up to promote the health law too. "The Blue Cross Blue Shield Association, comprising 38 state and local health plans including 14 owned by WellPoint Inc. (WLP), said today it will set up an educational website with Walgreen and distribute information in the retailer’s 8,000 stores. The campaign is aimed at encouraging people without insurance to use the government exchanges to shop for subsidized health plans." Alex Wayne in Bloomberg.

 

SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=bg52e9xhqr, moderationrequired=false, display_more=true, includefeaturenotification=true, comments_period=14, canvas_allcomments_id=washpost.com/km4ey0dajm, defaultsort=reverseChronological, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, includepause=true, display_ugc_photos=false, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=bg52e9xhqr, moderationrequired=false, display_more=true, includefeaturenotification=true, comments_period=14, canvas_allcomments_id=washpost.com/km4ey0dajm, defaultsort=reverseChronological, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, includepause=true, display_ugc_photos=false, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Comments
SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=bg52e9xhqr, moderationrequired=false, display_more=true, includefeaturenotification=true, comments_period=14, canvas_allcomments_id=washpost.com/km4ey0dajm, defaultsort=reverseChronological, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, includepause=true, display_ugc_photos=false, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=bg52e9xhqr, moderationrequired=false, display_more=true, includefeaturenotification=true, comments_period=14, canvas_allcomments_id=washpost.com/km4ey0dajm, defaultsort=reverseChronological, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, includepause=true, display_ugc_photos=false, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Show Comments
Most Read Business
Next Story
Neil Irwin | July 12, 2013