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Thursday, April 20, 2017 12:08 am

Both SIU and patients benefit from current health care law

Janet Albers (left) and Iris Wesley (right) from the SIU Center for Family Medicine and SIU School of Medicine.
PHOTO BY Lee Milner

 

On March 24, supporters of the Affordable Care Act, often called Obamacare, breathed a sigh of relief. This came after Republican U.S. House leaders withdrew the American Health Care Act, which would have repealed and replaced the ACA. The Republican health care act had failed to get enough support to pass.

Local supporters of the ACA include SIU School of Medicine and the school’s Center for Family Medicine.

Iris Wesley, administrative director at the SIU School of Medicine, said the percent of uninsured patients at the SIU Center for Family Medicine decreased from 15 percent to 3 percent after the ACA was enacted. This was a result of people obtaining health insurance coverage, and the expansion of Medicaid in Illinois.

At SIU Center for Family Medicine, about 50 percent of patients are Medicaid recipients, while about 25 percent are covered by Medicare. Illinois health centers, like the Center for Family Medicine, serve about 24 percent of all Medicaid beneficiaries in the state.

The Affordable Care Act of 2010 expanded funding to Federally Qualified Health Centers, providing grants to facilities such as the SIU Center for Family Medicine, which became an FQHC in 2012.

As a result of the federal grants, the facility has been able to provide its patients more services, such as legal assistance, women’s health, behavioral health, and nutrition and diabetes education. Janet Albers, chair of the Department of Family and Community Medicine at the SIU Center for Family Medicine, said being able to provide these services reduces the need to send patients to another facility for additional assistance.

“We are learning more that…about 20 percent of health are things from the medical perspective. The other 80 percent are all those things like environment, housing, food security and behavioral issues. All of those other things are really crucial too,” Albers said.

Federally qualified health centers with Medicaid expansion get a cost-based reimbursement for every Medicare and Medicaid patient. For SIU Center for Family Medicine, the reimbursement is about $130 per patient for Medicaid and $150 per patient for Medicare this year. Prior to 2012, the facility received little to no reimbursement.

 “It’s not for us to just get rich over it, it’s to put it back in the services for this most vulnerable population,” Albers said.

Albers said there are many “health harming” legal issues, such as environmental issues for people with asthma living in non-suitable areas. The facility provides free legal assistance for patients who are 200 percent below the federal poverty level.

“I can give all the inhalers I want to give but it’s not going to get any better if there is (for example) black mold growing in the apartment, and they can’t get the landlord to do anything about it,” she said. “The lawyer who works on site with us, she can help to do that.”

If the ACA were repealed and replaced, federal funding such as the Health Centers Fund could decrease by 70 percent. Facilities such as SIU Center for Family Medicine would suffer a loss in funding and in turn, loss in patients and services.

SIU Center for Family Medicine receives about $1.4 million in federal grants, which would decrease to about $400,000 if federal funding declined. About 92 percent of patients would lose access to care.

Supports of a “repeal and replace” act include U.S. Rep. Rodney Davis. In January he introduced HR 628, which would prohibit health insurance companies from excluding individuals with pre-existing conditions, a popular provision of the current law which many politicians on both sides want to retain.  

Opponents of the ACA argue that premiums and deductibles for health insurance have increased, and that millions of Americans cannot afford to use their health insurance under the ACA.

The failed Republican health care replacement plan would have changed Medicaid to block grants, affecting funding for medical schools such as the SIU School of Medicine in Springfield.

Wesley said the school receives a Primary Care Residency Expansion Grant, which allowed it to increase the number of resident physicians from 24 to 30. Prior to the ACA, the number of students choosing primary care as a career path was declining about 18 percent for the SIU School of Medicine.

“The school started with primary care in 1972. A lot of those doctors are retiring,” Wesley said. “That’s why we do what we do every day. It’s to make sure we have that next generation of physicians.”

Contact Debby Hernandez at editintern@illinoistimes.com.

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