Denial of Senior Health Care and ObamaCare on the Rise in San Angelo

Recently, the numbers of elderly patients being denied doctor visitation are on the rise. Locally, and all through the country, Americans are being denied doctor visitations if they have Medicare or a plan from the Affordable Care Act, commonly referred to as Obamacare.

Originally, when Obamacare was enacted, it increased Medicaid reimbursement rates for primary care physicians to Medicare levels. However, this increase only lasted for two years, 2013 and 2014. Now that the reimbursement rate has fallen, doctors cannot afford to accept patients with Obamacare or Medicare. In a 2014 Survey of American Physicians, officials reported that, “38 percent of physicians either do not see Medicaid patients or limit the number they see.” 

When Obamacare went into effect on March 23, 2010, it was intended to “provide more Americans with access to affordable health insurance, improving the quality of health care and health insurance, regulating the health insurance industry, and reducing health care spending in the US.”  The law had aimed to reform private and public health insurance systems so that up to 24 million Americans could have coverage by 2023. The goal of Obamacare is to give Americans access to more affordable, quality health insurance and reduce the growth in U.S. health care spending.There are many different types of insurance that fall under the affordable care act. The only problem: depending on the insurance company and the type of policy the holder has depicts what doctors will accept.

Some health clinics may accept Obamacare, but there are different types of insurance that fall under Obamacare. Obamacare is not one specific type of insurance. Blue Cross Blue Shield provides insurance through the Obamacare health insurance exchange.

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Medicare is the “federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD),” as stated by medicare.gov.  Medicare falls into four categories. Medicare Part A falls under hospital insurance, such as hospital stays, care in a nursing facility, hospice care and some home health care. Medicare Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services. Medicare Part C is offered by a private company associated with Medicare and incorporates Part A and B benefits as well as Private-Fee-for-Service, Special Needs Plans, and Medicare Medical Savings Account Plans. Medicare Plan D adds drug prescription coverage to the Original Medicare Cast Plans. All of this information can be found at https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html.

Local Shannon Medical Centers do accept Medicare. The hospital will bill Medicare for all services that the patient receives, but Medicare requires the hospital to ask questions regarding other insurance coverage to ensure Medicare is the primary insurance that the patient uses.

Some physicians that are affiliated with Shannon Medical Center include Toyha Harper and Grogory Lind that specialize in primary care.

One local senior resident with Medicare, Christine Castillo, said she has run into many problems here in San Angelo when trying to find a primary care physician. When Ms. Castillo moved here four years go, she said she began her search by looking in the yellow pages and tried calling five doctors she found listed. At that time, she had good insurance. She not only had Medicare, but she had a Medicare Supplement with United Health Care. She is a retiree of the State of Arizona. 

“I was very surprised that I wasn’t able to find a doctor that was accepting any new patients," Castillo said.

Castillo added that every doctor's office gave her the same response each time she called: "We're not accepting new patients." During this long battle, Ms. Castillo said, “I can’t understand why a town this small wasn’t accepting any new patients.”

When Castillo spoke with one of the office managers at a clinic that would not accept her as a new patient, the manager explained to her that her doctor would not accept Medicare anymore because they had lost a lot of money in the past by accepting patients that had Medicare insurance. Each office can only accept so many Medicare patients because, after the services and visits, the doctors were barely breaking even.

Luckily, after her long search, Ms. Castillo found La Esperanza.

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In Tom Green County, there are three La Esperanza clinic locations. The clinics serve the rural population in San Angelo and surrounding cities and exist to be there for patients who need a physician. Mike Campbell who is the Chief Executive Officer for the La Esperanza clinics had this to say about the clinic.

“La Esperanza Clinic accepts and provides primary, preventive health and dental care for all patients regardless to their documented ability or inability to pay, on a sliding fee scale," he said. "The clinic exists to provide primary health and dental services to those who are otherwise unable to obtain health care, i.e. uninsured, underinsured, disenfranchised form existing health care resources, or those who are seeking a comprehensive medical home where they are more than a number related to a market share measure.”

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He added that everyone is accepted at the La Esperanza clinic, whether the payer is private, public, subsidized, or self-pay. All of this includes coverage through ObamaCare or Medicare. In January of 2016 alone, 2,500 patients have been seen for physician services.

“Thirty percent were covered by either Medicare or commercial insurance,” Campbell said.

Ms. Castillo stated "I have stayed with La Esperanza. I haven't tried to find another doctor, because I am happy with the doctor I have." Ms. Castillo has been a patient at the La Esperanza clinic since 2012 and has been happy with the service that the La Esperanza clinic has provided to her.

The La Esperanza Clinic offers many physicians that are skilled in many fields. Amaris Allan, Charlene Chen, Randal Hirsch, and Kristie Mast specialize as a Family Medicine Physician.

Like Castillo, there is a rising number of patients being denied service of a physician and that's becoming an exponential problem around San Angelo and through the United States.If it wasn't for clinics like La Esperanza, many patients, especially the elderly, would be struggling to receive care. Betty Friedan, an an American writer, activist, and feminist stated that "aging is not lost youth but a new stage of opportunity and strength."  The elderly need to be given the chance to live the new stage in their live and be given opportunities and strength. They should not have to jump through hoops to be able to have affordable and reasonable healthcare to keep them healthy and strong, and be able to live a long and full life.