Some highlights and observations from the coverage of week three of Obamacare’s rollout:
Double shoutout. “The Unfulfilled Promise of Obamacare” by Time’s Kate Pickert (paywalled), and “National health care comes up against a very sick state,” by the Reno News & Review’s Dennis Myers, share last week’s shoutout.
Pickert offered Time readers a clear look at the Medicaid dilemma—that is, that the poorest of the uninsured won’t receive subsidies in the exchanges because their states opted out of the Medicaid expansion called for by the Affordable Care Act—and the opposition, by government officials in states that have opted out, to the rollout of Obamacare. In Florida, Gov. Rick Scott has blocked navigators from enrolling people at county health departments; in Missouri, the lieutenant governor advised residents not to sign up; in Texas, the insurance department said it would not enforce insurance rules set by the law; in Georgia, the insurance commissioner has said his department will do “everything in our power to be an obstructionist.” Time concluded that the “federal law will look very different depending on what part of the country you’re in.” Indeed it might, and Time showed how it looks for one woman in Texas.
Pickert told the story of Nicolette Cooksey, a part-time worker at a Houston day care center whose employer caps her hours at 19.5 a week—under its own 20 hour threshold so it doesn’t have to provide health insurance. She is also the mother of an autistic child and owes some $13,000 in medical bills she can’t pay on her salary of $8.10 an hour. “If I want anything in life I have to pay my medical bills first,” she said. Obamacare was to make this a thing of the past for her and others in similar predicaments. She is one of 1.7 million Texans without insurance, a number that gives the state the dubious honor of having the highest number of uninsured in the nation. Pickert noted that many local clinics that treat people like Cooksey receive federal funding which they are happy to take, a contrast with the governor who has declined federal dollars to expand Medicaid.
The health law pumps some $11 billion to what are called federally qualified health clinics to help treat the uninsured—a drop in the proverbial bucket compared to what’s needed, a point not often noted by reporters. Cooksey’s clinic, owned by Legacy Community Health Services, has grown. So have others in Houston. Harris Health, the county health care system, was expecting that some 400,000 annual visits would have been covered by Medicaid. According to Harris CEO David Lopez, even with more new clinics, the system won’t be able to meet the needs of Houston’s uninsured. Many will have to wait for care. “Honestly, we can double our volume today, and it still won’t be enough,” Lopez says. The story of where the poorest of the uninsured, now excluded from Obamacare, will get medical help will be a continuing story for years. Time has shown how it can be done, and done well.
For the Reno News & Review, Dennis Myers took a refreshing look at a another topic often ignored by the media. He reported on the poor health conditions in Nevada and what are commonly called the social determinants of health—things like poverty and income, housing, food, jobs. He wrote:
Nevada is a medical mess. It has become a local cliché to say that the Silver State is at the top of every bad list and the bottom of every good list. That problem has just been dropped on the federal doorstep.
To offer a flavor of what he meant, Myers noted the state’s minors are the most uninsured in the country. There is a shortage of doctors and nurses, and, Myers wrote, “in any other state, the Nevada mental health system would be a scandal.” He did point to a few improvements in rates of teen pregnancy and immunizations after the state embarked on educational campaigns. But, he noted, Nevada has rarely invested in such educational endeavors, and “The Affordable Care Act isn’t in the business of changing infrastructure, of creating programs or building facilities or training healthcare providers.” So can this law, Myers asked, “merely by providing insurance, upgrade a state that could easily be named Downgrade?”