Accessing Health Care

How are we doing on providing health coverage for all?

A Q&A with Dr. Ken Loving, CEO and family physician at Access Community Health Centers

Q: How does Access Community Health fit into the Dane County health care community?
We provide the full range of primary care services. The bulk of our patients lack insurance or don’t speak English or have a [lack of] transportation; some have a low health literacy level. We have a number of staffers who speak Spanish. Last year we had to coordinate translating or get interpretive services for over thirty languages. We’re a safety net provider, so we don’t want to duplicate services; we want to enhance overall care in our community so we work closely with all of the other health care systems.

Q: What mental-health services does Access provide? 
We take a really comprehensive approach because we’re a medical and dental clinic, and we have an integrated behavioral health program. When a medical provider is caring for a patient, a psychologist can also see the patient during the visit to provide counseling, screening for mental health disorders or help with behavioral modification. We think that’s innovative; that started five years ago. The United Way Health Council has made it a priority to expand this type of program into other health facilities. It’s a real benefit for patients.

Q: How has Access fared in the recession being a not-for-profit entity?
With our expansion in 2002 we became a federally qualified health center. Our federal designation provides us with five percent of our budget. About seventy-five percent of our revenue is from seeing patients. The rest of our budget comes from in-kind contributions, grants and community support. Community support makes a difference for us to grow. If we were just seeing patients and only depending on that we wouldn’t have been able to expand. In 2000 we saw about 2,500 patients. This past year we saw almost 25,000. But we don’t just want to grow to grow; it’s a matter of a community need that we’re trying to meet.

Q: In general who are Access’s clients?  
The uninsured are about thirty percent of the people we see. The sliding fee scale runs between the poverty line ($22,000 for a family of four) and twice the poverty line. We do a financial analysis and if the patient falls somewhere in that category, then we charge them accordingly.

The other large group of people we see are BadgerCare-eligible people. A third of our patients are under nineteen. And we do have some patients who have private insurance.

Q: The number of uninsured people will drop with the Affordable Health Care Act. What other provisions are in this act that will affect what Access does specifically?
There’s some debate on what’s going to happen. The idea is that people will shift off the Medicaid rolls and go into health insurance exchanges. And people who are uninsured now will be able to garner a subsidy for an insurance plan. That program is scheduled to start in 2014. In October the federal government is going to come out with the basics of what those plans will cover.

[Currently] if someone’s on Medicaid, they have covered services for mental and behavioral health and dental. What makes us effective [right now] is our ability to cover those areas. We will eventually end up doing a fair amount of work negotiating that health exchange for people because it might be a choice between hundreds of plans.

Q: Has access to quality health care gotten better or worse?
In Wisconsin we’ve done a good job of expanding coverage. Over ninety percent of residents are covered. Much of that coverage has happened through BadgerCare. The question that remains for the political arena is if that’s sustainable. BadgerCare goes beyond what a lot of states have for coverage. There are other states where the uninsured are closer to twenty-five percent.

We have a legislative liaison through the Wisconsin Primary Health Care Association. About one in seven people we see are Medicaid recipients. It’s widely recognized and supported that community health centers since the 1960s are a very important part of the health care delivery system, and we do it in a very efficient way.

Shayna Miller is associate and style editor of Madison Magazine.

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