Clinics need $3.4 million to maintain services, officials say
Wyandotte County’s safety net clinics, providing medical care for the needy, are reeling after taking three hits recently.
The safety net clinics in Wyandotte County tonight jointly asked the Unified Government Commission to help them out with $3.4 million to keep providing services.
• The first hit, according to local officials, was the failure of the Kansas Legislature to override the governor’s veto of the expansion of KanCare, the Kansas Medicaid program. Almost 12,000 residents in Wyandotte County will remain uninsured and not have health care because of the lack of expansion, said Jerry Jones, executive director of the Community Health Council of Wyandotte County. This is a $50 million loss to the community, he said. A lot of those people may end up at safety net clinics or in the hospitals’ emergency rooms, he said.
• The second hit was the new version of federal health care from the House, that would do away with the Affordable Care Act, make it impossible for lower-income residents to afford health insurance, and also prevent state Legislatures from expanding Medicaid. There were 6,000 people who signed up for the ACA in Wyandotte County, with an estimated 14,000 persons in the plans.
• The third hit was Wednesday, when Blue Cross and Blue Shield of Kansas City announced it would not offer or renew Affordable Care Act policies here for 2018, unless the policies were in effect before Oct. 1, 2013. Blue Cross and Blue Shield of Kansas City stated in a news release that it has lost more than $100 million since 2016 through providing ACA policies. Jones said only one provider is left in this market, Medica, which will only offer 10,000 plans combined for Wyandotte and Johnson counties. With Wyandotte County’s 6,000 plans purchased through ACA, with possibly 14,000 persons covered, he said, the economic loss could be more than $50 million lost in subsidies for health insurance premiums.
Jones said the Wyandotte County safety net clinics are having to put all of their resources into meeting the basic health care needs of clients. Last year, they served 22,994 Wyandotte County residents.
Jones said a community survey showed that before ACA, 18 percent of Wyandotte County residents delayed seeing a doctor because they couldn’t afford it, as compared to 11 percent statewide in Kansas.
The challenge now is how the safety net can prepare itself for the changes at the state and national level, he said.
“Our funding models are changing and we need help to sustain this strong asset that the county has,” Jones said.
The UG Commission took no action on the budget request tonight. It will be completing its budget this summer.
“I’m at a loss for what path to take forward,” Commissioner Brian McKiernan said. He said his research showed that local funding for safety net clinics is considered to be funding of last resort.
“I know stuff flows downhill and we’re at the bottom of the hill, but how did it get here?” McKiernan asked. The UG’s primary sources of funding are property tax and sales tax, he said. The UG already levies more tax than surrounding areas, and should be lowering it to benefit the citizens, he said. If the UG did a sales tax to fund the safety net clinics, the sales tax is a regressive tax and is always at the whim of the officials and voters, he said.
“I know there is a very real tangible social, but also economic, consequence to the gap that the clinics are feeling to their operation, but I am at my wits’ end as to figuring out what services do we not provide in the absence of an add-on sales tax, what services do we not fund to fill this gap?” he said.
In answer to a question from Commissioner Gayle Townsend, Dr. Sharon Lee, a family practice doctor with Family Health Care clinic on Southwest Boulevard, said about 30 percent of the safety net clinics’ work is in mental health.
Mayor Mark Holland noted that the UG had increased the mental health levy from $500,000 to $700,000 last year, after budget cuts were made at the state level, but it still remains low compared to other counties.
Jones said the $3.4 million being requested would just pay for uncompensated medical care the clinics are doing now, and does not include any changes that will occur when Blue Cross-Blue Shield of Kansas City leaves the market in 2018.
“It’s difficult to quantify the number of folks they keep out of the emergency room, but every time they’re in one of their clinics, it’s one more time they’re not in a waiting room at an emergency department,” Jones said.
Commissioner Jane Philbrook, a Doctor of Optometry, asked if the safety net clinics were doing contract for services with businesses, where the businesses could send their employees to the clinics.
Dr. Lee said the safety net clinics were doing a small amount of contracts with businesses, and were using creative solutions in several areas. They are small clinics, some with one doctor. While the clinics do a lot to keep patients out of the hospital, she said, sometimes they will still need to go to the emergency room, and will need insurance.
Commissioner Philbrook offered to put together a meeting between small employers and the safety net clinics to look at creating some sort of business relationship with local clinics, without local government involvement.
Commissioner Melissa Bynum noted that $3.4 million in uncompensated care divided by 12,000 people came out to less than $300 each. She also asked about the concept of concierge care, paying a flat fee directly to a provider on a monthly basis.
Jones said they were exploring different options currently. Dr. Lee said being as creative as possible is important, and they try all sorts of things. However, some of these solutions do not work well, she added.
Part of the issue is the level of poverty in the community, Dr. Lee said, and while they try different options, some of their clients just don’t have the money. There is still a point at which the floor is dropping with each passing day, Dr. Lee said.
She said one of the clinic’s funders has cut funds 10 percent the first year; the second year, 20 percent; and this year, 30 percent.
“Our funding partners are choosing not to continue to fund us at a level we’ve been funded at for 15 years,” Dr. Lee said. “I’ve been at this for 30 years, and I’m telling you, it’s looking really bad right now. We’re coming to you for help because it’s looking bad.”
Wyandotte County residents are hit hard by these recent changes, because of the large number of uninsured persons here, according to Mayor Holland. The number of uninsured here was 26 percent before the ACA went into effect, and was reduced to 14 percent by the program, he said. About 6,000 families, estimated at 14,000 to 18,000 people in Wyandotte County, would lose coverage under a House bill, he said.
Holland noted that the $3.4 million needed by the safety clinics is 10 percent of the county mill levy of 34 mills, which would be a significant tax increase.
The University of Kansas Hospital here is losing about $100 million a year in uncompensated care, Holland added, while Providence Medical Center is losing about $5 million to $10 million in uncompensated care. Wyandotte County accounts for about 40 percent of the uncompensated care at KU Hospital, according to Jones.
“There is a health care crisis in our nation and in our state,” Mayor Holland said. “I believe this is ultimately a state and federal issue, that the leadership in our state and federal governments need to take seriously and need to move forward.”
Expanding KanCare would have brought dramatic relief to the safety net clinics, with people having access to health care, and it would have helped KU Hospital and Providence Medical Center, lowering the cost of health care for everyone, he said.
While ACA had problems, those problems needed to be fixed, not the entire program repealed, Holland said. The House plan removes 23 million people nationwide, he added.
The mayor quoted from the Declaration of Independence, saying that “life, liberty and the pursuit of happiness” are fundamental truths, and that health care now fits into this category. The state and federal governments need to address these health care issues, he said. Now, even health clinics are on the brink.
“If we lose this group, the wall is gone and we have nothing, and our citizens in Wyandotte County deserve better than that,” Holland said.
To see a video with more information about this meeting, visit https://www.youtube.com/watch?v=abGPr8Q15N4.