Health centers key to outreach in reform



Two or three times a day, an intense pain crosses Timothy Gazaway’s chest and he wonders if he is having another heart attack. It is likely nerves pinched in his spine, he thinks, but he is not sure.

Because he is uninsured, he has been turned down for surgeries and is only now getting referrals to specialists through Medical Associates Plus at Belle Terrace, a Community Health Center in south Augusta.

He believes having health insurance, which he could sign up for once open enrollment begins in October through the Affordable Care Act, would make a big difference for him next year.

“Doctors wouldn’t hesitate,” to see him, Gazaway said. “They wouldn’t blink an eye.”

But he, like millions of others who will be eligible to enroll, has a lot of questions and some confusion about what will be available under health reform. And places such as Medical Associates are now trying to begin to reach out and educate those who might be helped.

Gazaway, for instance, said he was told that in October “everyone will have mandatory Medicaid or you can apply for it.” But Georgia, like many other states, is not expanding Medicaid despite the fact that the federal government will pay 100 percent of the costs for the first three years and no less than 90 percent thereafter.

Gazaway is not alone in the need for education on what is coming, said Janice Sherman, the CEO of Medical Associates, who held an early informational session for some of its patients last week.

“They have no idea,” she said.

Sitting among about a half dozen at Medical Associates, Diamondnique Yancey said the time frame was a surprise.

“I didn’t know it would be this soon,” she said.

Others had simple questions such as whether the premiums for the new insurance will just be charged to their credit cards. That will be one way but those insurance companies that will be selling through the Health Insurance Marketplace will also have to accommodate the “unbanked,” those who don’t have credit cards or checking or bank accounts, said Cindy Zeldin, that executive director for Georgians for a Healthy Future.

A recently proposed rule says the insurance sold through the exchange must “at a minimum accept a variety of payment formats, including, but not limited to, paper checks, cashier’s checks, money orders, and replenishable pre-paid debit cards.”

For Rosalyn Williams, 40, who is studying health administration through the University of Phoenix and working part time, health care right now is strictly a cash transaction.

“I have to think about how much it is going to cost,” she said. “I have to save up this amount of money in order to come back and have this done.”

Those are seemingly basic but important details, Sherman said.

“For the people that we serve, I know that is going to be an issue,” she said.

While the initial meetings are bringing people in, the clinic is also distributing materials at events such as a recent job fair, where the headline on the clinic’s sign, “Uninsured?” drew some questions and interest, said Terri Gant, a community outreach manager.

“You have individuals who are job searching who are underemployed and underserved in health care as well,” she said.

And again, also some who were surprised when she explained it.

“There are quite a few people who are not aware that this is even happening,” Gant said.

The clinic is using a grant to do outreach, which includes a billboard and a phone number for people to call and request information. The clinic is working to hire a bilingual outreach person to help with those who don’t speak English well. The hope is to build up a database and also to help tailor some of the educational materials based on the questions people are asking, Sherman said.

“So that we can start to develop things around responses that would prove more helpful,” she said.

The database will be important for the next phase, which is the follow-up, Sherman said. It will mean getting back to them to find out if they have actually signed up and asking “Do you need help facilitating that?” she said. “Will you come back? It is going to take that kind of work.”

That is likely where the bottleneck will be, Sherman said. The clinic alone has around 2,000 patients who might need to be enrolled.

“That’s a large number of folks to get signed up,” Sherman said.

The clinic is doing that through a federal grant and also plans to do community education and enrollment coordination, which might be trickier.

“It is a little bit easier for us to educate our patients and to involve them and try and facilitate the enrollment,” she said. But there might be a large number of folks who are uninsured who are not even seeking care at this point, Sherman said.

“I think that’s the bigger challenge is how do you reach those,” she said. Medical Associates plans to do outreach at nontraditional places, such as grocery stores, barbershops and hair salons, Sherman said.

Just getting health insurance in some way would be helpful for Gazaway, as family nurse practitioner Diana Ramirez at Medical Associates ran through his list of ills and tried to sort out how many specialists he will need to see. He had an MRI to help diagnose his spinal problems but he can’t get access to it now.

“We’ll just have to start over again,” Ramirez said. She notices he is also on an anticoagulant whose levels need to be monitored.

“Who’s following you on your Coumadin?” Ramirez asks.

“You,” Gazaway said.

At the very least, he comes away with a referral to a cardiologist and he is hopeful for a neurology consultation before September. As bad as he feels, however, his is the least of his family’s problems.

His daughter, Carol-Ann Davis, 21, was diagnosed with advanced chronic lymphocytic leukemia in June and doctors have given her less that a year to live, Gazaway said. He and his wife “dropped everything” when she was diagnosed and moved down to the Augusta area from northern Georgia to be with her and her 2-year-old daughter, Zoey.

“We are on rock bottom,” he said. “It’s very rough.”

For now Gazaway and his family are helping to care for Zoey and he dreads eventually having to break the news to her.

“I don’t know how we’re going to explain it,” he said.

Who will be affected by health reform enrollment in October?
Feds 'working with' Georgia even as plans drop out of exchange
Official: "Evolving" evidence led to health law delays