"Can I talk to you about insurance?"

As an Insurance Specialist, the crux of my position can be summed up in one word: enrollment. I begin every day by reviewing each doctor’s list of appointments to determine which patients have insurance and make a note of who does not. As the patients arrive, I speak to those without insurance individually. Asking them about citizen/immigration status, income, and family size, I can determine if they are eligible for either Medical Assistance (Medicaid) or a Marketplace plan and request they bring necessary documents for the respective application. 

Unfortunately, follow up is not nearly as straightforward.  Patients often do not meet citizen or immigration status requirements for Medicaid. In fact, I have had several days where I met with ten or more patients, and only one may be eligible. Those who are eligible often cannot easily return with the documentation since they are working during the health center’s hours. Others express frustration over past encounters with the County Assistance Office and are reticent to subject themselves to being shuffled around once again. In its third year,the ACA’s online Insurance Marketplace improved significantly from the first two generations. The website is functional and user-friendly. The Affordable Care Act provides tax credits for low income families above the Medicaid limits. Nonetheless, the patients I serve frequently run into the systematic limits of the ACA. Legally present immigrants, whose status disqualifies them from Medicaid, often do not earn enough to file income taxes. Thus, they do not qualify for tax credits, rendering the most basic Marketplace option unaffordable.

It is easy to focus on these seeming insurmountable issues in providing coverage to less fortunate populations. The 200 people I had to inform that they were not eligible for any health insurance they could afford may leave me feeling discouraged. However, recognizing that no system is perfect, I focus on the good that Medicaid, its expansion, and the passage of the ACA provides. Since beginning my service term, I have successfully enrolled 24 people in Medicaid, 4 adults in ACA plans, and have several applications pending.

The benefits to these patients are two-fold. First, Health Center 2 waives copayments of insured patients, saving them money with every visit. Also, many studies show that insured patients utilize more healthcare services, especially primary care, compared to uninsured patients. This increased usage leads to better prevention and management of adverse health outcomes and decreased admittance to emergency rooms. The specific requirements for Medicaid and the ACA limit who I am able to help, but every successful enrollment is one step closer in closing the coverage gap.

Second, an increase in insured patients also benefits the health center. As a community health center, Health Center 2 will see all patients, regardless of immigration or insurance status. Copays for visits range from $5-20, depending on the services rendered. For the uninsured, this is the maximum the health center can collect.  Conversely, the center can collect more ten- or more-fold from insurance companies. This money helps offset the cost to care other patients and maintain the quality of care. It is here that I best see my position contributing to the patients’ and community in general health.
 

This blog post was written by NHC Philadelphia member Mory Bell.
Mory serves as an Insurance Specialist at Philadelphia Department of Public Health - Ambulatory Health Services: Health Center 2