The Impact of Healthcare Reform on Local Providers

Staff Reports

Every week millions of people fall through the cracks of our healthcare delivery system. Private charity, public hospitals, and local governments try to fill the gap, and all will be impacted by whatever reforms are enacted.

ABCCM

For many years the Medical Ministry of the Asheville-Buncombe Community Christian Ministry has been filling the gap between the uninsured and decent basic healthcare. The clinic on Livingston Street charges no fees to its clients, and it doesn’t pay the doctors, dentists, and other medical professionals, who volunteer there. The small staff, who are paid, coordinate it all.

According to Rev. Scott Rogers, ABCCM Executive Director, “We serve
the working uninsured who can’t afford insurance, or people who are
between jobs, or lost a job and can’t find a new one, or they’re
working but their employer cancelled their insurance plan.” The clinic
offers medical treatment, some preventative services, dental cleaning,
extractions, and fillings, and prescriptions. Even with those limited
services, public demand continues to grow.

Asked about the Congressional proposals under discussion, Rogers
says, “Right now the need is so overwhelming, with the current economic
downturn, we’re turning folks away almost every session. So what we
want is to get the gap down to a manageable level. Any regulatory
changes that will shrink that gap are a plus for us.”

ABCCM works closely with Mission Healthcare, which matches funds
raised from individuals, businesses, and local churches. “We’ve helped
build demonstration projects with both public and private service
providers, within the regulations that were out there,” says Rogers.
“We did a demonstration project in 2005 using a new system of care that
leverages private and public support for the good of the community.”

Buncombe County Health Center

That model is now being used by the Buncombe County Health
Center. A steady increase in the need for clinical services for
low-income people has strained the Center to the breaking point,
according to Director Gibbie Harris. Approximately 24 percent of county
residents have no health insurance, including 45 percent of employed
minority residents and about eight percent of white workers. The
Center’s adult and child primary care caseload is approaching 10,000,
with another 800 adults waiting to get in.

Faced with trying to find another $1 million to add to the
existing primary care service budget of $3.5 million, the Center chose
a different approach. Beginning in January, the Health Center will
transfer its entire adult and child primary care caseload to Western
North Carolina Community Health Services (WNCCHS). WNCCHS is a
“Federally Qualified Healthcare Facility,” a designation county health
departments can’t obtain. An FQHF is eligible for higher federal
subsidies and reimbursement rates than health departments. The
difference is significant: Buncombe County’s contribution for primary
care at WNCCHS will be only $2.3 million per year.

Harris said that patients can be assured that their care won’t
suffer with the transition. Several Health Center staff, including
doctors, are transferring along with the patients. WNCCHS services for
children and families will be offered at the existing West Asheville
clinic, 10 Ridgelawn Rd.; the adult primary care clinic will be at 256
Biltmore Ave.

Harris expects healthcare and health insurance reform
legislation to have a positive effect on both WNCCHS and some programs
remaining at the Health Center, though the size of the impact will
depend on the specifics of the final bill. A public insurance option
might reduce the percentage of uninsured people on the WNCCHS caseload
and allow more comprehensive services for their patients. Money
appropriated for disease prevention could bolster Health Center public
outreach programs.

Buncombe County Detention Facility

Another government entity, the Buncombe County Detention
Facility, spent about $1.4 million on medical services last year,
according to Sheriff’s Dept. Major Glen Matyabas. A million of that
went to a private contractor for general inmate care; hospital charges
and treatment for mental health and substance abuse each took another
$200,000.

“This is mostly money from our operating budget,” Matyabas said. “The citizens of Buncombe County pay for it with their taxes.”

The detention facility processed 17,000 people in 2008, many of
them homeless and up to 60 percent having mental illness or substance
abuse issues. Matyabas noted that the jail attempts only to “maintain”
the inmate health, not diagnose new problems or treat currently
untreated conditions. “We’re not going to send an inmate to the dentist
for a gold crown,” he said. But the budget is still vulnerable to each
person it jails: last year one inmate’s treatment alone cost the
department over $100,000.

The Sheriff’s Dept. has considered buying health insurance for
inmates rather than paying out of pocket. Ironically, the jail finds
itself in much the same situation as small business owners. “We’re too
small to get a good rate,” Matyabas said. “The premium would be about
the same as we’re paying now.”

So the department relies on innovative interagency cooperation
and outreach to hold down costs and reduce recidivism. Matyabas
estimated that 30% of the crimes presently committed by mentally ill or
substance-abusing people might have been avoided if treatment were
readily available.

Healthcare reform legislation that includes a public option
could be a big help to the Sheriff’s Dept., Matyabas said, depending on
how many uninsured people it covers, whether the coverage continues in
jail, and whether mental health and substance-abuse benefits are
included in the package.