Health care overhaul has some clinics preparing for rush of new patients

Connie Walsh
Connie Walsh, United Family Medicine's lead patient advocate, in her St. Paul office on Dec. 12, 2013.
Elizabeth Stawicki/MPR News

Community health centers are hiring more people to prepare for an influx of new patients who are now covered because of the federal health care law.

The law expanded Medicaid and provided some people with premium discounts through the state's new online insurance marketplace, MNsure. As a result, community health centers expect to see a 12 to 15 percent rise in the number of patients this year.

At United Family Medicine, a community health clinic in St Paul, the new patients will include a man who showed up on its doorstep about a week ago. Connie Walsh, United Family's lead patient advocate said the man in his mid 50s, who'd been diagnosed with multiple sclerosis a decade ago, had gone for years without health care because he couldn't afford the state's high risk pool premiums.

The man, whom Walsh did not want to name him to protect his privacy, obtained health coverage through MNsure.

"[He] will start to come to our clinic and just to play catch up with all of his needs because he hasn't had any health care for 3 or 4 years," Walsh said. "He's going to have quite a few appointments in January and February."

United Family Medicine expects to see its number of patients jump from 19,000 to 23,000, which translates into another 13,000 patient visits for 2014.

Community health centers will see more, and probably sicker patients in the near term, said Jonathan Watson, public policy director for the Minnesota Association of Community Health Centers, which represents about 60 clinic sites throughout the state.

"Hopefully we get them in the primary care system and really drive down the health care costs for them, keep them out of the emergency room and provide some savings overall," Watson said.

Most community health clinic patients have low incomes. Roughly 95 percent have incomes below 200 percent of the federal poverty level -- for a single earner, that's less than 23,000 annually; for a family four about 47,000.

Many of these people will be covered under Medical Assistance or MinnesotaCare with a few buying private insurance on MNsure with the help of tax credits.

Nevertheless, Watson said community health clinics will still have to treat at least 50,000 patients who will remain uninsured. They include people exempt from the law -- some of whom are barred from government coverage such as people who are in the country illegally.

Others are able to sign up for coverage but have decided not to. In the first year of the new law, they will be fined 1 percent of their income or $95, whichever is greater. The fine will increase in coming years.

Precisely how the makeup of community health clinic patients will change has yet to be determined as the federal health care law's major coverage provisions just took effect. But there is a potential road map in the experience of Massachusetts, which went through a similar health care overhaul in 2006. Its law served as a model for the federal health care law.

While the number of patients in Massachusetts grew in the first year after the change, the biggest surge came in the second year. At the time, academics predicted that once patients had coverage they'd migrate to private health systems, but that didn't happen, said James Hunt Jr., president of the Massachusetts League of Community Health Centers.

From 2006, Massachusetts Community Health Centers treated 594,000 patients. That number grew to 642,000 in 2007 and to 712,000 patients in 2008.

"So instead of losing patients who might have mobility with their new insurance card, we not only kept the patients we had but we grew in the patients that were registered at community health centers," Hunt said.

Walsh, who began her career more than 40 years ago as an intensive care nurse, using a watch to time IVs that are now computerized, looks forward to Minnesota's health care transition.

"Our health care system is changing, and that's a good thing," Walsh said. "It's not perfect by any stretch of the imagination, but we're so much better than we were 40 years ago, 20 years ago, 10 years ago."

United Family Medicine has already hired one physician and is hiring another provider such as a nurse practitioner to meet the growing caseload.

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