Illustration by Courtney Quirin.

As enrollment for the Affordable Care Act kicks off today, local health officials say that not only can uninsured patients in the Mission District expect better coverage, their clinics will make more money.

“It’s going to drastically change our ability to provide services and be financially stable,” said Dawn Harbatkin, executive director and medical director for Lyon-Martin Health Services on Market Street, a clinic that only a few years ago considered closing because of its balance sheet.

Like other clinics in the Mission, Lyon-Martin is expanding its staff to help patients sign up for extended coverage made possible through the sweeping health reform that President Obama signed into law in 2010.

The six-month enrollment period that begins today means that uninsured patients will have the rare opportunity to take advantage of wide-ranging health coverage and that clinics will soon see higher payments for patient care.

For many Mission residents who have gone without health insurance, this change represents an upgrade, even for those already covered under Healthy San Francisco, the city’s health access program, or through the federally funded SF PATH.

Calling it “landmark legislation,” Mission Neighborhood Health Center Executive Director Brenda Storey pointed out the downside of Healthy San Francisco. “If something were to happen to you outside the city, you are not covered [under Healthy San Francisco],” she said. With insurance, however, patients can choose to travel without fear of getting hurt and racking up hospital bills. They also have the option of moving outside the city without losing coverage.

Rachael Kagan, the chief communications officer for San Francisco General Hospital agreed: “We’re proud of Healthy San Francisco, but it really is a sort of stopgap for folks who aren’t insured. If you have the opportunity to become insured, that’s always going to be better.”

Also, the payments clinics stand to receive from insurance will be higher. Under the new health plans, Lyon-Martin’s Harbatkin said her clinic would receive upwards of $100 per patient visit from a third-party payer — five times what the clinic now receives from uninsured patients paying out of pocket.

Healthy San Francisco, Harbatkin said, does not reimburse for each visit but instead pays a set fee of $119 for each person Lyon-Martin enrolls in the program.

California was the first state in the nation to pass legislation toward implementing the Affordable Care Act by creating Covered California, the health care marketplace where Californians will apply for coverage under the new law.

Through Covered California, residents can compare and choose health coverage, and some may qualify for financial assistance or be eligible for the state’s expanded Medi-Cal program.

At Lyon-Martin, 70 percent of the roughly 2,000 patients are uninsured. Harbatkin said she expects that about 1,000 patients, or half of Lyon-Martin’s client base, will be eligible for the expanded Medi-Cal. Another 300 patients will likely be eligible for Covered California with some amount of subsidy. About 100, she estimated, may be ineligible or choose not to enroll.

To help with the potential 1,300 enrollments, Lyon-Martin has hired one additional staff member who starts this week. That’s in addition to the four existing staff members who work on Healthy San Francisco enrollment.

The staff will take part in training for Covered California provided by the state, Harbatkin said.

Lyon-Martin is also looking at collaborating with the San Francisco LGBT Community Center across the street to serve as an additional location for patients to enroll, Harbatkin said.

Mission Neighborhood Health Center has hired one additional staff person and has plans to hire a second to work on enrollment and outreach in the center’s four clinics, Storey said. The center is also setting up an appointment system where patients will have the chance to talk one-on-one with a staff member about enrolling in the new programs. Her staff is also participating in trainings provided through Covered California.

Larry Hicks, an information officer for Covered California, said that 5.3 million Californians are estimated to be eligible to enroll in the exchange, and half of those will be eligible to receive some sort of financial assistance.

A million or more people, Hicks said, will be newly eligible for the expanded Medi-Cal that begins on Jan. 1. At that time, Medi-Cal will expand to include people under 65, including those with disabilities; it will cover single individuals with an income of less than $15,856 and families of four with an income of less than $32,499. For those who qualify, Medi-Cal coverage is free.

Almost 400,000 people under 65 in the Bay Area will be eligible for subsidies through the Covered California exchange, while just over 180,000 people under 65 will be newly eligible for Medi-Cal, according to the California Simulation of Insurance Markets, or CalSIM, a collaboration between the University of California, Los Angeles Center for Health Policy Research and the University of California, Berkeley Center for Labor Research and Education.

Not everyone will qualify for the new programs under the Affordable Care Act, however, and undocumented Californians fall into that group. Those who don’t qualify or are exempt from programs under the new law will be able to remain in Healthy San Francisco, said Emily Riggs, interim director of Healthy San Francisco.

The program will be smaller, Riggs said, estimating that the current patient load of 50,000 in Healthy San Francisco will drop to about 20,000 once everyone who is eligible makes the transition.

SF PATH, which provides affordable medical care to San Francisco residents who meet certain federal requirements, will end, Riggs said, and all of the 10,000 patients who are a part of it will be transitioned to Medi-Cal or Covered California.

Healthy San Francisco may not have been a boon to clinics’ bottom lines, but the existence of the program has put the city “light years ahead” of other locations, said John Gressman, the president and CEO of the San Francisco Community Clinic Consortium and one of the founders of Healthy San Francisco.

Because of it, San Francisco has identified many uninsured residents and connected them with primary care providers. “We’re not starting from scratch,” Gressman said. “A lot of places across the country are starting from scratch.”

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Lynne Shallcross was stressed and tired after walking three miles without finding an open community clinic. “Is this what it's like for Mission residents who work full-time?” she wondered. Having walked in their shoes, she feels compelled to write about accessible healthcare in the Mission.

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1 Comment

  1. I’m curious where the increased payments are coming from? Do the clinics seen the boost in funds coming from the expansion of Medicaid in the ACA or are they becoming part of HMO networks and will be providers to people getting insurance on the exchange? I was thinking that smaller clinics that historically served the uninsured would actually lose some business as patient access to other options increased.

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