Slide 1

Julie Darnell, PhD, MHSA Assistant Professor, Division of Health Policy & Administration School of Public Health University of Illinois at Chicago May 3, 2013 Georgia Charitable Clinic Network 9 th Annual Conference 10 Reasons Why Free & Charitable Clinics are Needed After the Affordable Care Act Slide 2 Health Reform is an Historic Achievement Extends health coverage to ~30 million people Expands the healthcare safety net Individual mandate Subsidies Employer penalties Medicaid expansion Health Benefit Exchanges Health centers Increases Medicaid provider payments National Health Service Corps Training Nurse-managed clinics Encourages focus on quality & outcomes Provider/consumer engagement Public reporting Data collection Payment reform QUALITYACCESS Slide 3 Gaps remain Slide 4 #1: There will be gaps in coverage. Slide 5 Gaps in coverage: 29 million uninsured in 2019 Slide 6 ~15 TIMES the number of free clinic patients Slide 7 The Uninsured Who are they?How many? Unauthorized/Undocumented11 million Medicaid eligible but not enrolledNext largest Unaffordable coverage Not eligible for Medicaid because of Supreme Court Exempt from penalty due to hardship Not exempt from penalty.6 million < 100% FPL 2.4 million 100-300% FPL In between coverage? Source: Congressional Budget Office. (2012). Payments of Penalties for Being Uninsured under the Affordable Care Act. Slide 8 Who Faces the Penalty? Total nonelderly population = 268.8 million Source: The Urban Institute. (2012). How Many Might Have to Pay the Individual Mandates Fine? 33% 58% 3% 4% State option to reject; Supreme Court ruling millions Slide 9 Washington Oregon California Nevada Idaho Montana Wyoming Colorado Utah New Mexico Arizona Texas Oklahoma Kansas Nebraska South Dakota North Dakota Minnesota Wisconsin Illinois Iowa Missouri Arkansas Louisiana Alabama Tennessee Michigan Pennsylvania New York Vermont Georgia Florida Mississippi Kentucky South Carolina North Carolina Maryland Ohio Delaware Indiana West Virginia New Jersey Connecticut Massachusetts Maine Rhode Island Virginia New Hampshire Michigan (upper penisula) Alaska Hawaii Source: Hoefer, Rytina and Baker (2009). http://dhs.gov/xlibrary/assets/statistics/publications/ois_ill_pe_2008.pdf 75% of Unauthorized Population in 10 States Slide 10 Click on a state to change color Free Clinics Report That They Regularly Seek to Serve Immigrants Source: Darnell, J. (2010). Free Clinics in the United States. Archives of Internal Medicine. Slide 11 Medicaid Eligible but Not Enrolled Characteristics Variation in Medicaid participation rates Older Male Married White Hispanic Very low income Not having a chronic illness Being in overall better health Working full-time Slide 12 Coverage is Unaffordable Slide 13 WILLING to Pay?EXPECTED to Pay? Average annual premium contribution for family: $3,996 Sources: Kaiser Family Foundation and Health Research and Educational Trust Employer Health Benefits 2010 Annual Survey; Kaiser Family Foundation Subsidy Calculator Medicaid Premium Amount Slide 14 Percentage of Free Clinics that See Insured Patients Source: Darnell, J. (2010). Free Clinics in the United States. Archives of Internal Medicine. Slide 15 #2: There will be gaps in services. Slide 16 Gaps in Services Source: Darnell, J. (2010). Free Clinics in the United States. Archives of Internal Medicine. Percent of Clinics Services not included among Essential Health Benefits Slide 17 #3: There will be gaps in the availability of providers. Slide 18 Gaps in the Availability of Providers Severe provider workforce shortage Downward pressures on health centers Areas not designated as medically underserved Providers unwilling to see Medicaid patients Slide 19 Access to Care Problems Persist in Massachusetts People couldnt get the care they needed 17% of people because of cost 1 32% of nonelderly adults Percentage of NC Patients Achieving Selected Chronic Disease Outcomes, 2011 Outcome NC Free clinicsHRSA NC 2010 NC BRFSS 2010 Healthy People 2020 2 A1c tests74.1Not available64.0-73.871.0% A1c922.424.6Not available14.6 Retinal exam35.3Not available70.958.7 Foot exam61.0Not available76.774.8 mAI test53.5Not available80.637.0 Education72.2Not available53.962.5 Rx refill as expected (diabetes) 66.7Not available BP under control67.853.9Not available61.2 Rx refill as expected (hypertension) 64.5Not available Slide 32 Accreditation/Certification/Recognition Self-imposed or external set of standards Creates a culture of goal attainment and attention to quality Little tangible value NC Assoc. of Free Clinics- self VA Assoc. of Free Clinics- self WV Association medical clinic members - NCQA SC Assoc. of Free Clinics-self 2012 20032008 2011 Slide 33 #9: Free clinics are nimble. Slide 34 History of Free Clinics Free clinic movement Focus on the poor Focus on uninsured 1960s 1970s1980s1990s 2000s Slide 35 #10: Free clinics have expertise serving the nations most vulnerable populations. Slide 36 Free clinics will constitute a litmus test of the success of the reformed health system. Slide 37 Thank You Julie Darnell jdarnell@uic.edu 773-263-0533 (cell) Slide 38 Questions?