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Affordable Care Act May Prevent Trips To The ER

Aileen LeBlanc

The Affordable Care Act may make it easier to get preventative care for many people who may now be using the emergency room. People who put off getting check-ups and tests for minor issues can find themselves with a serious illness. Even a bad tooth, if it is ignored, can manifest into a life-threatening situation.

Joseph Akif, director of nursing for emergency services at Via Christi Hospitals in Wichita, says that when the economic crisis hit in 2008, the emergency department saw an increase in these kinds of patients.
“A lot of people who didn’t have the money would wait longer to come and get care," he says. "So when they did get to the ED, they did have a higher acute situation [which would] end up in admissions at that point in time. Whereas, if they could have maintained that preventative care - other care outside of the hospitals in a physicians office or clinic - they may have averted that admission to the emergency department.”

Keisha Humprhies is an oncology service line administrator for Via Christi Hospitals in Wichita. She's concerned about cancer patients understanding the new Affordable Care Act and getting the financial help they need during such a difficult time in their lives.

Emergency Rooms More Expensive Than Clinics

A single trip to the emergency department can casts thousands of dollars and Akif says when people come in for sickness due to colds and flu, they do not necessarily find quick treatment. The most serious cases are always taken first so the wait might be longer than a few minutes.

Via Christi and Wesley are writing off large unpaid health care bills each month. And, though hospitals expect to have this financial load, one wonders what health care costs would be if the hospitals were buying equipment, doing more clinical trials or hiring more of the best medical staff with those write-off dollars.

The Clinic

A visit to a doctor’s office, urgent care center or clinic is often more efficient for both patient and health care facility.

GraceMed is one of several clinics in the Wichita area designed to be there for people who have no insurance – or for people who’s insurance does not help much with doctors’ visits, check ups and simple lab tests. It’s a safety net.

Obamacare makes it possible for some people with lower incomes to buy insurance which includes basic tests and visits.

Dave Sanford who is the CEO of GraceMed says that half of his patents are uninsured and half of them have insurance or are subsidized with Medicare, Medicaid (KanCare) or other state or federal help with costs.

And that, frankly, keeps his place open for business.

“We know that we have to keep that balance between the two or we would go broke and have to close our doors," he says. "And so we really advocate for KanCare, Medicare, private insured patients because we have to get more of those folks in order to provide more care for more uninsured people.”

He is looking to get 5 to 10 percent of his 14,000 currently uninsured patients to sign up, which would increase those patients’ abilities to pay more for services, and allow him to expand his care to more who still do not qualify.

Dave Sanford explains how "navigators" will help uninsured patients find health insurance through the new insurance marketplace, which opens October 1.

Donut Hole

In Kansas, the ACA has a hole because the state did not accept the federal expansion of Medicaid, which was part of the original act. So there is a group of people who make too much for assistance on Medicaid (KanCare) and too little for tax credits on the new insurance marketplace.

These people left in the hole will essentially be where they were before: not able to afford insurance. They might then put off their health care (unless they find the clinics) and make trips to the emergency department with illnesses that could cost Kansans money and take fathers and mothers from their families who rely on them.

More Information

A good place to start for all Kansans is the state insurance department website: insureKS.org.

KMUW hosted a live call-in show on Oct 9, 2013 to address questions about how the Affordable Care Act is going to affect individuals and businesses in Kansas. Check out our archive of those questions and answers from our experts to find out even more about how the Affordable Care Act is going to affect you.

Follow the on-going coverage of the Affordable Care Act with more reports from KMUW News and NPR.