Health insurance update: Who falls in the coverage gap and how can they get insured?

Health insurance update: Who falls in the coverage gap and how can they get insured?

“I think most of the providers that volunteer feel a moral and ethical obligation to help take care of those people.” — Dr. David Loewy, volunteer with We Care of Polk County

LOCAL RESIDENTS who have issues getting health insurance coverage are fortunate in that there are many agencies here that offer a wide range of services to meet the needs of those who otherwise would go untreated.

There have historically been many residents who are unable to obtain health insurance for various reasons. And today, it is estimated that more than 850,000 Floridians have been unable to get health insurance because of a gap between Medicaid qualifications and the Affordable Care Act. After the U.S. Supreme Court left it up to states to decide whether to expand Medicaid, Florida decision-makers chose not to expand. That left thousands in the limbo area that’s being dubbed as the “coverage gap.”

While local healthcare professionals say the offerings are not complete — and healthcare needs certainly still exist — thousands of people are regularly being diagnosed and treated by way of non-profit agencies and volunteers.

Lakeland Volunteers in Medicine, We Care of Polk County, county organizations — the Affordable Care Act — all offer various types of help for those who need it, healthcare professionals say. “These patients would be lost in the cracks otherwise, and would not receive any care,” says Dr. David Loewy, a Winter Haven ophthalmologist and volunteer with We Care of Polk County. “It is a complex issue,” he explains. “The way our healthcare system and our society has chosen to deal with these kinds of issues leaves that gap — and they would go without care.”

“I have patients who otherwise might go permanently blind,” observes Dr. Loewy, who’s also a Polk County Medical Association member. Patients treated via the program are processed through the organization’s administrative office, and then go directly to the physician’s offices for care.

Dr. Loewy, who has been volunteering his services since the organization started in 1998, says he most often provides eye exams, treatment for glaucoma, or cataract surgery. Polk residents who meet the agency’s criteria may also be treated in a wide range of other areas, including gastroenterology, urology, pathology, orthopedics, dermatology, gynecology, and cardiology.

In the six-month period that ended in March of this year, 476 patients received care through We Care of Polk County. And since 1999, We Care has provided more than $20 million in volunteer specialty medical care to the community. “I think most of the providers that volunteer feel a moral and ethical obligation to help take care of those people,” Dr. Loewy says. “And we are compensated well (in their practices).”

Dr. Glen Barden, an orthopedic surgeon and one of the founders of Lakeland Volunteers in Medicine, says today’s healthcare issues have made it imperative that communities offer forms of assistance to meet the needs of people who otherwise would suffer.

There are many reasons why people may not be covered by a health insurance policy, and some of them are caused by not having benefits through their job due to lack of hours or income specifics. The gap between people who make “too much money” to qualify for Medicaid and those who make enough to obtain insurance by way of the Affordable Care Act is showing its human face by way of those who seek help from the various organizations available in the county. “It is something that is not new, but is continuing and probably becoming a little bit more serious,” Dr. Barden says. “It has become not only a societal, but also a political issue in Florida. And closure of that gap has not happened. This is often where we see the problem. And most are hard-working people that we see, and they are often suffering.”

While Dr. Barden was careful not to criticize the many employers who treat employees well and have high integrity, he observes that lack of coverage in the workplace is often the root of the problem with the uninsured. The Affordable Care Act requires employers to provide health insurance for their full-time employees. And as a result, “the employers have dropped their hours down,” he observes. “If say at 30 hours they have to provide some sort of health benefit structure, then what happens is some companies will cut hours so that they no longer have to provide health insurance.”

Dr. Barden says a number of patients he has seen have had to get second jobs to make ends meet because of the decreased hours at their primary place of work. “So now, they have had to get a second job just to survive. And then some companies will offer the option to buy healthcare coverage with them at the group rate; however, when employees are only working 28 hours a week, they can’t afford it. So then they really are stuck.”

And so the help is offered. The organizations that offer healthcare assistance locally cannot fully meet the needs of the uninsured, Dr. Barden points out, but they make a tremendous difference. “At least this offers some opportunity for healthcare,” he says. “And where I think we do our best at Lakeland Volunteers in Medicine is in the area of primary care.” If a person has diabetes, for example, the organization can diagnose and seek support from large pharmaceutical companies to obtain assistance to pay for necessary medications.

There are frustrations, however. “Where we don’t do as well, for instance, say in orthopedics we may have a patient who needs a total knee joint replacement; there is no budgetary capability to supply that. Our budget would be decimated.”

Other agencies help residents determine if they can obtain insurance via the Affordable Care Act, the Polk Health Care Plan, or other options. Ermelinda Centeno, of Central Florida Health Care, Inc., works to help residents determine if they qualify for health insurance and to become familiar with the Affordable Care Act. She is a navigation supervisor, and that’s an apt term for what has to happen for residents to find the right plan and determine eligibility. It can be quite complicated.

“We have 10 certified application counselors, who are patient-centered medical home navigators,” she elaborates. “Our role as a navigator is to eliminate any barrier to access care.” The agency also helps residents with Medicaid and food stamp applications and recertification assistance.

“If you don’t have health insurance or lost it, you should always come and see us even though the Marketplace (Affordable Care Act) enrollment is closed,” she continues. “Because maybe you would qualify for certain enrollment qualifications.” Their offices are busy, she reports. Recent quarterly data showed that out of 1,843 applications processed there, some 1,557 obtained insurance.

In addition to other options already mentioned, there is also the Florida Children’s Health Insurance Plan, and the Polk County Health Care Plan.

Scott Sjoblom, spokesman for the Florida Department of Health in Polk County, urges residents to ask questions, contact agencies they are referred to and be diligent in seeking assistance. The Department of Health also offers many services. “We are the safety net for the community,” he says. “What we see is the low-income portion of the community that generally does qualify for Medicaid-type services.”

Ashley Rivera, CEO of We Care of Polk County, says working with groups that offer health care for those who need it is extremely satisfying for the staff and for volunteers. He is personally enjoying the work tremendously since he came on board about six months ago from a private healthcare industry position. “I get to hear a story of a patient who didn’t know what they had, then all of a sudden they find out they don’t need to go to the hospital after all — it really is gratifying. Especially when it saves a life.”

“A lot of individuals are unaware that free clinics are not here to encourage people to not get health insurance,” he explains. “They are for people who don’t have the means — and a lot of people don’t know that. They might go on with their lives and just deal with the pain until they drop and die. All because they do not know that these services are available.”

WE CARE OF POLK COUNTY, INC.

Started in 1998 as an initiative of the Polk County Medical Association, it has 215 providers — 186 are volunteer physicians. We Care provides low-income, uninsured Polk County residents with access to high-quality, volunteer specialty medical care.

Eligibility guidelines: Family income of 200 percent of the Federal Poverty Level (FPL) or less. Individuals must not be eligible for any source of funded medical care unless the provider is not available. Individuals must have a very significant and serious medical condition that cannot be managed or treated by a primary care physician.

Office hours: 8 a.m. to 4 p.m., by appointment only.
Phone: (863) 701-8070
Fax: (863) 701-8077
Administrative Building
4315 Highland Park Blvd, Suite B
Lakeland, FL 33813

Areas of specialty:

Gastroenterology
Pulmonology
Breast Surgery
Radiation Therapy
Urology
Neurology and Neurosurgery
Anesthesiology
Radiology
Pathology
Ophthalmology
Optometry
General Surgery
Orthopedics
Dermatology
Podiatry
Gynecology
Endocrinology
Rheumatology
Cardiology
Ancillary Services

Donations are welcomed and can be made by contacting Ashley Rivera, CEO, directly. Phone: (863) 701-8070 or (863) 397-3614. Email: ashley.rivera@wecarepolk.onmicrosoft.com.

FLORIDA DEPARTMENT OF HEALTH IN POLK COUNTY

Administration Building
1290 Golfview Ave
Bartow, FL 33830
(863) 519-7900
polkcommunications@flhealth.gov
www.mypolkhealth.org

LAKELAND VOLUNTEERS IN MEDICINE

1021 Lakeland Hills Blvd.
Lakeland, FL 33805
(863) 688-5846
Clinic Hours: Monday 9 a.m.-2 p.m.
Tuesday through Friday, 8 a.m.-4:30 p.m.

CENTRAL FLORIDA HEALTH CARE, INC.

www.cfhconline.org
Offices:
Avon Park (863) 452-3000
Dundee (863) 419-3330
Frostproof (863) 635-4891
Wauchula locations (863) 767-0696 and (863) 773-2111
Lake Wales (863) 678-4360
Lakeland (863) 413-8600
Mulberry (863) 425-6200
Winter Haven (863) 292-4290

CREDIT

feature by MARY TOOTHMAN

Categories: Features, Health News