Lessons Learned on Local Impacts of Health Reform
This post was jointly written by Noozhawk reporters Giana Magnoli and Lara Cooper.
Reporters Lara Cooper and Giana Magnoli worked together on this extensive project that spent about six months looking at the network of care and the expected changes coming next year.
Safety-net patients – the uninsured, the homeless and Medi-Cal participants – are served by public health department clinics and a series of private clinics throughout the county. The lack of a public hospital and 24-hour urgent care providers results in high demand on local emergency rooms.
Even with organizations meeting regularly and partnering to provide care, there are serious gaps in services. The uninsured often delay or forego care altogether, which leads to preventable illness and years of life lost, said Dr. Takashi Wada, head of the county’s Public Health Department.
The 70,000 uninsured people of Santa Barbara County is expected to decrease to 20,000, but the undocumented population will remain uninsured – as the law is written now.
It’s no secret that the county, like many others, struggles with providing mental health care, but the shortage of beds and inpatient facilities means that emergency room beds are frequently filled with mentally ill patients on holds until beds opens up elsewhere. Of course, wait times skyrocket for everyone else as a result.
The biggest challenge in front-line health stories is getting access to patients and doctors. With privacy laws like HIPPA and liability concerns, health-care facilities are notoriously cautious of allowing outsiders access. To get past this, we worked with two different providers to arrange shadowing opportunities: The Cottage Health System, which operates three hospitals, and Santa Barbara Neighborhood Clinics, which manages three medical and one dental clinic.
Following the advice of Anna Gorman from the Los Angeles Times, we wrote up waiver forms for every patient we interviewed about their medical care and every person we used for photographs inside the health-care facilities. It reassured the providers that they weren’t breaking HIPPA and covered us from any liability issues since everything was done with permission and written consent.
This was a vital piece to the project for us, since we wanted to share real patient stories as well as overview information. It was our fear that this safety-net care story would end up a series of articles about insurance.
We approached the leaders of Cottage and the Neighborhood Clinics to discuss our project from the start, and they agreed to collaborate as much as possible with access and information.
Most of our readers are not the safety-net patients that we wrote so much about, so we needed to connect to them with personal stories. The series also made it clear that having a large population of uninsured residents has an impact on everyone else’s health care, through insurance premium rates and emergency room waits.
Our initial reporting took six months, which included shadowing and countless interviews with health care providers, patients and administrators. We asked about how the system worked now, and how it was expected to change with the Affordable Care Act.
As we kept trying to look ahead, more decisions were made that rendered the Affordable Care Act’s local impacts unclear. The business mandate was delayed, the Covered California exchange opened without all of its plans and providers finalized, and our local Neighborhood Clinics organization revealed that it was so deep in the red it could close by the end of the year, leaving 17,000 patients a year without doctors.
The one word we heard over and over again was “uncertainty.” We heard it from CenCal Health, the Medi-Cal provider for the county, we heard it from hospitals and we heard it from clinics.
Doctors are more optimistic, particularly about the Medi-Cal expansion. More people will become eligible for health benefits, which could divert some patients away from the emergency room and into clinics for primary care.
There is a serious demand issue in Santa Barbara. Some people with insurance plans go to the emergency room anyway, since they can’t get appointments with their primary doctors. Local hospitals are even providing charity care – free acute care that’s usually given to the uninsured – to insured patients who can’t afford the deductibles on their insurance plans.
It can be tough to recruit physicians to Santa Barbara with the high cost of living, particularly the lower-paid primary care doctors who sometimes earn a quarter of what a specialist does.
“It’s a combination of lifestyle and compensation, and the debt as medical school has gotten more and more expensive,” said Sansum Clinic CEO Kurt Ransohoff. “If you graduate with $250,000 of loans on top of your college loans, the choice of your career is driven oftentimes by the ability to pay off your loans.”
Even though we started this fellowship with a time frame in mind, our coverage on the Affordable Care Act’s impacts will continue for years. This project gave us a strong foundation.
We’re more prepared to cover health care news in the future; our newfound knowledge has already proven its worth when it comes to Affordable Care Act updates.
As the Covered California exchanges went online for pre-enrollment, we realized that the largest provider of primary and specialty care in southern Santa Barbara County (the Sansum Clinic, with 23 clinics) wasn’t initially included as a provider for exchange plans. That starts a whole new conversation: There are plans available for everyone, but what providers are included in those networks?
The exchange piece is perplexing even the experts, and people are wondering what happens if no one signs up. What if all employers decide to risk penalties and drop their employees to the exchange system? What if providers are flooded with so many new patients, appointments get even harder to make?
One of the largest employers, UC Santa Barbara, talked about changing its health plan completely and eliminating treatment options at the local hospital or Sansum Clinic. Thousands of people are being kicked off their current insurance plans because they’re not “ACA compatible” and will have to go shopping for new insurance just like the currently uninsured.
With a subject as complicated as health care, we learned it’s OK to not have all the answers yet. Some things are uncertain, and it’s irresponsible reporting to just throw out all the hypothetical situations.
We wrote about what people are preparing for, what people are expecting, and what they just don’t know yet.
This fellowship project reminded us how important clear, accurate health care stories are to the community, and the relationships we built in our reporting will help us with coverage in the future.