Opinion: Falling short of Obamacare’s goals in Washington state

Excluding Medicaid managed-care plans from the state’s health-care exchange will undermine Obamacare

I AM one of many health providers in Washington state with deep concerns regarding the decision by state Insurance Commissioner Mike Kreidler to include only commercial health-insurance plans in the state’s new Health Benefit Exchange.

The exchange is billed as an online marketplace to help consumers shop for competitively priced, affordable health-insurance plans, an important feature of the federal Affordable Care Act, aka Obamacare.

As medical director of Sea Mar Community Health Centers and a practicing physician with 23 years of experience, I find it troubling that Medicaid managed-care plans — such as Community Health Plan of Washington (CHPW), Molina Healthcare of Washington, and Coordinated Care Company — will not be available on the exchange.

Medicaid was created by the federal government to help low-income families get access to health care. The decision by Kreidler, if implemented, will hurt people served by Medicaid managed-care plans.

For years, these plans have worked well for low-income families due in large part to a partnership with a network of community health centers across the state. These plans help people who are underinsured or cannot afford health insurance — the same people the Affordable Care Act hopes to bring under the nation’s health-care umbrella.

Nationally, community health centers have been in existence for more than 45 years and have proved to be effective at reducing unnecessary hospitalizations and emergency-room visits, saving the health-care system $24 billion annually.

Through Sea Mar’s network of 60-plus health clinics and facilities in nine Western Washington counties, we saw nearly 250,000 clients and patients in 2012 and 2013 alone, and had almost 1 million encounters. Of these, 90 percent of visits qualified as low-income under federal or state guidelines.

Sea Mar, like many of our sister community health centers, has a long-standing policy of not refusing service to anyone, including those who cannot afford to pay. The availability of Medicaid managed-care health plans have made this possible.

Studies show patients choose community health centers because they are convenient, affordable and offer a range of services from a team of caring professionals, many of whom speak multiple languages. This allows our centers to better serve diverse groups, including people who are new to our state and country and speak little or no English.

Community health centers and Medicaid managed-care plans are working in 30 of Washington’s 39 counties. Including them in the state’s exchange would provide more choices for patients.

A number of these communities have only a single option in their area. By excluding Medicaid managed-care plans from the state’s exchange, families would no longer be able to see a single provider or seek care in the same location, further burdening those who don’t have cars.

For them, community health centers provide one-stop shopping for services such as health education, nutritional guidance, social workers, interpreters, eligibility assistance, chronic-disease management and dental and mental-health services.

Kreidler’s decision to select only commercial plans will result in higher premiums, an estimated 30 percent increase, for people who can least afford it. This not only is unfair and potentially harmful for the affected individuals, it undermines the intent of the Affordable Care Act to expand health care to traditionally underserved communities.

My fear is more of these families will choose to remain uninsured and we would remain a state where quality, sustainable health care remains elusive for the most vulnerable.

The exchange’s board of directors should extend the deadline for determining which plans should participate. And Kreidler should work with Medicaid managed-care companies and allow for their plans to be resubmitted and evaluated.

Dr. Ricardo Jimenez is medical director of Sea Mar Community Health Centers. Email ricardojimenez@sea-marchc.org

The above was originally published in the Seattle Times on August 14, 2013.