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California Hospital Workers Pitch Obamacare To ER Patients

Jan 14, 2014
Originally published on January 14, 2014 11:10 am

Angela Felan is sitting in the ER waiting room at O'Connor Hospital in San Jose, Calif. A blue surgical mask covers her nose and mouth, and a sweatshirt is pulled snug over her head.

She first came into the emergency room a few days ago with what she thought was bronchitis. The doctor prescribed an inhaler that cost her $56.

Felan, 31, works part time in retail and hasn't had insurance for at least a decade because she hasn't been able to afford it. "Unfortunately even not having insurance is just as expensive," she says.

Felan has heard of the state's insurance exchange, called Covered California, but she worries that coverage will still be pricey. She's unsure whether she will qualify for subsidies for private insurance because of her low income, or even Medicaid. "As far as today goes, I'm expecting another large bill from the hospital," Felan says. "Previously, when I would come in uninsured, I would get like a $200 or $300 bill for just one visit."

Some 5,000 uninsured people come into O'Connor Hospital's emergency department each year, and now it is Araceli Martinez's job to help them find coverage. She runs the Health Benefits Resource Center just down the hall from the ER. The center has beefed up staffing and hours in response to the Affordable Care Act.

Martinez says uninsured patients had few options before 2014 to pay off hefty hospital bills or enroll in health coverage. Now when they come in through the emergency room and are faced with a bill, they're saying they might be able to afford coverage.

Still, patients remain confused about the law. Half of uninsured adults who could get policies now through the health insurance marketplaces have never thought about buying insurance on their own before, and, in California, nearly half of poor adults don't know they would qualify for Medicaid. Martinez estimates that 70 percent of the uninsured patients she sees can now get coverage, if they follow up and apply.

Hospitals have extra motivation to sign up patients for insurance because they also face Medicare cuts. As for Medicaid, 26 states and the District of Columbia have opened the program up to most poor adults. That means if an uninsured patient is found eligible, hospitals can get paid retroactively for medical treatments going as far back as three months.

"I think the emergency department waiting room is one of those places where you have low-hanging fruit," says Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco. "They're not the sickest of the sick, because at least someone, the triage nurse, has deemed them stable enough to wait. And if they're waiting, they might as well be filling out some application form, or at least learning about the process."

O'Connor Hospital CEO Jim Dover doesn't expect to get a whole lot more money if more people are signed up for Medicaid. California has one of the lowest reimbursement rates in the nation. Even so, he sees it as a worthy goal.

Dover says he wants to get patients insured so they don't have to come to the ER for common problems. "Let me use this metaphor: A person is coming down the river, and they're drowning, and you jump in and pull them out. And then they come down again, and you pull them out. Next. Two. Three. Four. Five. At some point, you have to go up the river and take care of the spot where they're all falling in."

Angela Felan emerges from seeing the doctor clutching a stack of papers. The doctor told her she had a worrisome ear infection and needs antibiotics. When she came to the emergency department a few days ago, the discharge nurse didn't mention anything about new insurance options. But at the end of this visit, she says, "someone said they would give me a financial packet, and I could call the number on that and someone would go over financial options with me."

Calling later sounds good to Felan. She has spent enough time in the ER and is ready to rest. "You just want to go home and just relax and not deal with anything because your head is pounding and you just don't feel good," she says.

Copyright 2018 Kaiser Health News. To see more, visit Kaiser Health News.

STEVE INSKEEP, HOST:

Many states put a lot of effort and money into getting the word out about the new insurance options - setting up tables at churches, flea markets, and colleges. One place where you can almost guarantee that you will run into an uninsured person is in the hospital. Reporter Sarah Varney went to a hospital in California to see how much people in an emergency waiting room knew about their new options.

SARAH VARNEY, BYLINE: Of the many people I met in the emergency department waiting room at O'Connor Hospital in San Jose, California, most patients appeared to have the flu, bronchitis, pneumonia. One guy had gout on his leg. Want to see it, he asked me.

(SOUNDBITE OF COUGHING)

VARNEY: Sitting across the room is Angela Felan. A blue surgical mask covers her nose and mouth, and a sweatshirt is pulled snug over her head.

ANGELA FELAN: I just kind of decided to come in because my roommate had pneumonia and I just really wanted to make sure I didn't have that.

VARNEY: Angela first came into the emergency room a few days ago with what she thought was bronchitis. The doctor prescribed the 31-year old an inhaler which cost her $56. She works part-time in retail and hasn't had insurance for at least a decade.

FELAN: It's just been too expensive, and unfortunately, even not having insurance is just as expensive.

VARNEY: She's heard of the state's insurance exchange - called Covered California - but she worries coverage will still be pricey. She's unaware that she might quality for subsidies for private insurance, because of her low income, or even Medicaid.

FELAN: As far as today goes, I'm expecting another large bill from the hospital. Previously, when I would come in uninsured, I would get like a $200 or $300 bill for just one visit.

VARNEY: About 5,000 uninsured people come into O'Connor Hospital's ER each year, and now it's Araceli Martinez's job to help them find insurance. She runs the Health Benefits Resource Center just down the hall from the ER which has beefed up staffing and hours in response to the Affordable Care Act. She says prior to 2014, uninsured patients had few options to pay off hefty hospital bills or enroll in health coverage.

ARACELI MARTINEZ: Now they have a bill, because they came in through emergency room, they see things that's going on in the news, and at that time they're saying, well, maybe I can afford something.

VARNEY: Still, patients remain thoroughly befuddled. About half of uninsured adults who could get policies now through the health insurance marketplaces have never done so before. And, in California, about half of poor adults don't know they would qualify for Medicaid. Martinez estimates seven out of ten of the uninsured patients she sees can now get coverage, if those patients follow up and apply.

Hospitals are motivated to sign patients up. For those who qualify for subsidized, private insurance, the reimbursement rates are welcome revenue at a time when hospitals are facing step cuts from Medicare. As for Medicaid, 26 states have opened it up to most poor adults, and that means if an uninsured patient, like Angela, is found eligible, hospitals can get paid - retroactively - for medical treatments going as far back as three months.

RENEE HSIA: I think the emergency department waiting room is one of those places where you have low hanging fruit.

VARNEY: Renee Hsia is an associate professor of emergency medicine at the University of California, San Francisco.

HSIA: And if they're waiting, they might as well be filling out some application form, or at least learning about the process.

VARNEY: The president of O'Connor Hospital, Jim Dover, says he wants to get patients insured, so they don't have to come to the ER for common problems.

JIM DOVER: Let me use this metaphor: A person is coming down the river and they're drowning, and you jump in and pull them out. And then they come down again, and you jump in. The next - two - three - four - five. At some point, you have to go up the river and take care of the spot where they're all falling in.

(SOUNDBITE OF HOSPITAL)

VARNEY: The crowd staring blankly at the TVs in the emergency department waiting room - or corralling sick and grumpy children - did not seem to be in the mood to sign up for health insurance. Angela emerged from seeing the doctor clutching a stack of papers. The doctor told her she had a worrisome ear infection and needed antibiotics.

Did anyone talk to you about your insurance options when you checked out?

FELAN: Last week, no. But today, someone said they would give me a financial packet, and I could call the number on that and somebody would go over financial options with me.

VARNEY: Calling later sounded good to Angela. She had spent enough time in the ER and was ready to rest.

FELAN: It's kind of like you just want to go home and just relax and not have to deal with anything 'cause your head is pounding. And you just don't feel good and you don't want to deal with everything.

(SOUNDBITE OF COUGHING)

VARNEY: For NPR News, I'm Sarah Varney. Transcript provided by NPR, Copyright NPR.