Affordable Care Act May Fill Rural Clinics

A rural clinic in Northern Arizona is bracing for an influx of patients once the details of today’s Supreme Court ruling on healthcare shake out. Non-profit community health centers have long filled in the gaps of the nation’s health system by taking care of uninsured or underinsured patients. 

On a typical morning several people line up for their appointments at one of 14 North Country Community Health Centers in Arizona. Jen Cody brought her three sons in for their annual check ups. Cody had just heard the news of the Supreme Court ruling upholding President Obama’s health care law. She says she doesn’t think anyone should be required to get insurance.

"That’s way way way too much government for me," Cody said. "And I don’t want to be forced to have insurance. I like to have it and I choose to have it. If I was forced to have it there may be times I couldn’t afford it. And how do I do that?"

"That’s absurd," responded Jeff Barnaby, a new dad bringing his infant son in for an exam. "That just baffles my mind that people with no insurance who can’t afford insurance are opposed to the idea of a new plan coming in that would actually make it accessible to them. I truly don’t understand that."

Many people here are focused on the individual insurance mandate. Eric Henley is North Country’s Chief Medical Officer. And he sees the court’s ruling as good news. About 55 percent of his patients are on Medicare or Medicaid. Another 20 percent have no insurance at all.

"We see everyday the dilemmas of people who need care and are uninsured and don’t know how they can pay for it," Henley said. "And it’s tremendously frustrating to us and tremendously difficult for them, things like how to take care of fractures or whether they can get an MRI for a problem headache they’ve been having."

But with so many people now required to get insurance, Henley anticipates a lot more patients.
And he’s not quite sure how the clinic will handle the expected influx -- all the people in rural northern Arizona who have for years avoided seeing a doctor.

"When people go from the uninsured state to the insured state they ask for more care because they have pent up demand understandably," he added. 

Henley’s concerned about having the resources -- both staff and operations -- to handle the this pent up demand. A few years ago North Country received stimulus money that helped the clinic expand. But federal funds to community health centers have tapered off.

"It’s one thing to say there will be more insured people but what’s the supply what’s the availability of the resources to take care of them and that’s been constrained by the budgets at both the federal and state level over the last year and a half," Henley said.

Private practices typically can't afford to take on the type of patients that come here. The reimbursements are lower and the paperwork is time consuming. But as a non profit, North Country can serve the poor because some patients have private insurance and the clinic receives a small amount of federal funding.

Places like North Country are important to Jen Cody who says she worries about being able to get an appointment when her kids get sick.

"I would imagine that there’s going to be patient overflow at places like this and county hospitals. I would imagine that it’s going to be more of a strain," Cody predicted.

The mandate that requires people to have health insurance will be implemented in 18 months.