Kenai Peninsula health care providers are looking at potential effects of the Medicaid expansion currently being debated in the state legislature.
Governor Bill Walker introduced a bill in March to offer Medicaid coverage to adults whose annual income is below 138 percent of the federal poverty level — less than $20,313 per year.
According to the state Department of Health and Social Services, which administers Medicaid in Alaska, the expansion would offer Medicaid to 40,000 new users statewide, including 5,830 in the Kenai Peninsula region.
Monieque Essig of Soldotna is currently uninsured. She said she has been unemployed for three years due to problems such as alcoholism, bipolar disorder, depression, and post-traumatic stress disorder.
She goes to mental health sessions given by the non-profit Peninsula Central Health Services, to which she said she pays a $20 co-payment for her care, using PCHS’s sliding-fee scale policy for low-income people.
Essig is ineligible for both Medicaid and for insurance subsidies under the Affordable Care Act. She said that neither recognizes her problems as qualifying disorders.
“I’m the person who falls through the crack,” Essig said. “Because I’m 51. I’m not pregnant, I’m not physically disabled or anything like that. I don’t have any children.”
Under expanded Medicaid, adults like Essig who lack other qualifying conditions such as dependents, pregnancies, or recognized disabilities will be eligible for Medicaid if they meet the low-income requirement.
Monica Adams, CEO of Peninsula Central Health Services, said that uninsured people like Essig are a significant portion of PCHS’s users.
“Our mission to care for the under-insured and uninsured,” Adams said.
“However, when you have a high proportion of patients who are uninsured it hurts your financial viability. Last year 17 percent of our patients were uninsured. That rose from the previous year of 13 percent.”
Adams said PCHS provides about $3 million a year in charity care, equaling 21 percent of its annual budget.
“Without Medicaid expansion, we’re going to have to look at reducing services and reducing our ability to care for our community as this rises,” Adams said.
Adams said that caring for the potential 5,830 new Medicaid users on the Peninsula would not be difficult for PCHS.
Many of them are in the uninsured population PCHS currently serves without compensation.
“We have the capacity to serve those patients,” Adams said. “We’re serving a lot of them now. And all (Medicaid expansion) is going to do for us is help us stay in business. Because you can’t continue with 21 percent of your budget going to charity care and remain viable.”
Of the 17 percent of PCHS users who are uninsured, Adams said that “if we can even have 25 to 40 percent of those insured, that would really help, and then we can take on an additional 1,000 to 2,000 new patients without a problem… We actually have been preparing. We’ve been gearing up for Medicaid expansion over the last year, so we’re fully staffed and ready to take on new medical and dental patients… It looks very clear to us that Medicaid expansion will happen.”
Essig said she has received physical care from Central Peninsula Hospital, in addition to mental health treatments through PCHS.
“If I have to go to the hospital, I go to the hospital,” Essig said.
She recently went to Central Peninsula Hospital for treatment of a kidney problem.
“I get the bill, and since I can’t pay it I have to take it in there and try to get help for that,” Essig said.
Central Peninsula Hospital CEO Rick Davis said that in 2014, the hospital spent $20 million in charity care and patient loans that were not repaid.
Davis said that Medicaid expansion would reduce charity care not only by paying for the emergency room services for the currently uninsured, but also by helping them avoid costly emergency care.
“It would allow them to seek primary care services before they got so sick they had to go to the emergency room,” Davis said. “
Now, without any coverage at all, they don’t have the ability to seek regular primary care, and they’re forced to wait until their problem exacerbates to the point where they have to come to the emergency room. Then we care for them out of our pocket.”
Lisa Tennin is another uninsured Peninsula resident who doesn’t meet the requirements of either Medicaid or Affordable Care Act subsidies.
Tennin said she lost health insurance shortly after having a brain surgery in 2003, and that another recent neurological problem had incurred more debt and difficulty.
“A couple years back I had a seizure in Safeway,” Tennin said. “Fell and hit my head — woke up in the emergency room. That was a huge bill right there.”
Tennin receives health care at Kenai’s Dena’ina Wellness Center, but said she has to travel to an Anchorage hospital for CT scans and MRIs that she is unable to pay for.
“All Natives, whether insured or not, are able to get services here,” said Kenaitze Indian Tribe Health Systems Director Dr. John Molina, speaking of the Dena’ina Wellness Center. Molina said that the Dena’ina Wellness center receives appropriations for uninsured care from the federal Indian Health Services, but that uninsured patients like Tennin who require specialized treatment beyond the Wellness Center can have problems.
Molina said that Indian Health Services does provide funding for uninsured patients to receive care at outside hospitals for emergencies such as car accidents and trauma, “but if it’s something that’s not emergent, they’re basically on their own.”
“Where it becomes an issue is if they have to be sent out, “ Molina said.
“If they go to any other private hospital, that’s when they’re really uninsured and have no other way to cover that care.”
Molina said that about 30 percent of the 5,000 people enrolled for care at the Dena’ina Wellness Center are uninsured, while 40 percent are current Medicaid recipients.
Molina estimated that the Medicaid expansion would increase Medicaid enrollment at the Wellness center by 25 percent, or about 500 people.
Reach Ben Boettger at firstname.lastname@example.org