On Thursday the first phase of the federal Patient Protection and Affordable Care Act went into effect. Venice Patch sat down with the head of the nation's largest health clinic to discuss the anticipated impact.
Elizabeth Benson Forer is executive director of the Venice Family Clinic, which has been providing health care to thousands of low-income and uninsured patients for more than 40 years.
Venice Patch: Who is affected by this new law?
Elizabeth Benson Forer: In some ways, everyone who uses the health care system in America will be affected by it, either directly or indirectly.
But the intent of the law is to keep the elements of today's system that work, so people who are currently insured and are happy with their coverage should not necessarily see a difference.
Patch: How does it work?
EBF: The law will do lots of things, but the centerpiece is insurance reform.
Insurers will no longer be able to deny coverage based on preexisting conditions, to drop the coverage of people who become sick, or to charge higher premiums based on an individual's health issues.
Small employers will receive tax credits to help pay for coverage for their employers. Large employers will have to provide health insurance to their employees or pay penalties.
Individuals will have to obtain coverage or pay a penalty. And the federal government will provide Medicaid coverage or subsidies to help lower-income Americans purchase their insurance.
Patch: What will it cost?
EBF: According to the Congressional Budget Office, the law is estimated to cost just over $1 trillion over 10 years. [For context, the sum of all health care spending in 2009—before passage of the law—was estimated at $2.5 trillion, according to the Centers for Medicare and Medicaid Services.] The increase will be paid for through a combination of Medicare savings, taxes on high-cost health plans, new fees on the health industry and other revenues.
Patch: What are the long-term goals of the reform package?
EBF: Clearly, the goal is to make health care more accessible to more people by making it more affordable and to thereby stabilize the health care system.
Many people don't know just how close the system is to collapse.
In Los Angeles for example, the system as it is could never handle a large natural disaster, terrorist attack or epidemic and that's just the emergency side of it. Primary care is the foundation of the system, hence the name, yet there are entire neighborhoods with little or no primary care capacity.
It's also a matter of global competitiveness. Just as a population can't compete if it doesn't have a robust educational system, it can't compete if it doesn't have an adequate health care system. In the simplest terms, it's a matter of productivity.
But it also goes beyond that. It's a humanitarian issue, and what it really comes down to is this: What kind of world do we want to live in?
Patch: What are the major effects of this reform?
EBF: First, all health plans are now required to allow children to remain on their parents' health plans until age 26.
Also, employer-sponsored health plans will no longer be allowed to refuse coverage to children under 19 with serious medical conditions.
In addition, employer-sponsored plans will be barred from setting annual dollar coverage limits less than $750,000, and those limits will increase each year until 2014, when limits will no longer be allowed at all.
There will also be some rules taking effect regarding preventive care and copayments for new plans purchased since March.
Patch: What kind of changes can people expect in their health care services?
EBF: Right now, many uninsured people avoid the health care system because they can't pay for care and they worry about getting hit with huge bills.
Currently, Medicaid, known in California as Medi-Cal, covers only low-income kids and aged, blind and disabled adults with income limits usually at or near 100% of the poverty level, which is $10,830 annually for an individual income.
In 2014, the law will expand Medicaid eligibility to all Americans who earn up to $14,430 a year.
This is a very significant change and one that will impact Venice Family Clinic and its patients profoundly.
Right now, only about 20 percent of the clinic's patients have Medi-Cal. Around half of the other 80 percent will get covered by this change alone, and we hope many of those who don't qualify for coverage under the expansion will still be able to obtain private coverage thanks to the subsidies.
Either way, Venice Family Clinic will continue to see the neediest of the needy, focusing on the uninsured and people who have difficulty accessing health care.
This is especially important when you consider that the law will not cover everyone. It is estimated that 15 million to 23 million people nationwide, including about 2.4 million Californians will remain uninsured even after the law takes full effect.
In fiscal year 2010, the Rose Avenue location of the Venice Family Clinic saw 14,348 patients in about 50,000 visits. One in five of those patients was homeless.In 2007, the last year of available data, there were approximately 55,000 uninsured people in the area of Los Angeles between the 105 freeway and Mulholland, west of La Cienega, which is about 8 percent of the population.
One of the challenges will be to educate people who are new to the system— where to go for care, how to follow a treatment plan etc. It will be years before some of the changes are evident because we will need time to get people's health back on track.
Patch: Are doctor's offices going to be busier?
EBF: This really depends on the type of doctor and what kinds of insurance they accept, but many primary care physicians stand to see a substantial increase in demand.
Currently, the rates paid by the government to health care providers who accept Medicaid [or Medi-Cal] is relatively low, so many providers refuse to accept it. Those rates will go up steadily under the law, so hopefully more providers will accept it. Those who do could become quite a bit busier.
But even those who accept private insurance should be busier since low-income people who do not qualify for Medicaid will receive subsidies to purchase private coverage.
For these reasons, the law also includes incentives to encourage more medical students to go into family medicine, pediatrics and other areas of primary care.
Patch: What does this mean for the Venice Family Clinic?
EBF: There once was a time when Venice Family Clinic's leadership spoke longingly of the day when health care reform would put the clinic out of business, but now it's clear that Venice Family Clinic will be crucial to the implementation of reform, because it has the doctors and it has the facilities, but also because it has the experience treating low-income populations.
I expect more people to seek out Venice Family Clinic's services as they obtain insurance.
Right now, the clinic treats about 24,400 patients annually, about three-quarters of whom are uninsured.
The share of uninsured will decrease in 2014, but the number of people in need of care will be identical—in other words, everyone.
Venice Family Clinic recently opened a new site in Mar Vista, and it is about to create a new dental clinic in Santa Monica.
Everyone I work with is very excited for 2014, when the most sweeping reforms take effect. Venice Family Clinic has been caring for people with low incomes and no health insurance for 40 years now, and although it has never been able to meet the entire need in its community, it's exciting to think it might be able to someday.
This is the first of a series of stories on Venice Patch about how health care reform will affect the Venice Family Clinic and the community as a whole.
