Signing up new patients is just the beginning

A boy rides a scooter past abandoned homes on August 20, 2013 in the Whitman Park neighborhood of Camden, New Jersey. The town of Camden, which was once a large industrial town but watched it's population dwindle as manufacturing left, has been marred with societal problems including high unemployment, crime, murder and heavy drug trafficking for decades.

Uninsured Americans have just 15 days left to enroll for health coverage through one of the exchanges before the Affordable Care Act’s March 31 deadline.  

But when it comes to Medicaid – the health plan for people with low-incomes – there is no deadline. People can, and are, signing up. In Camden, New Jersey – the community Marketplace is watching throughout the ACA's first year – thousands of applications are pouring in every month, and all three of the city’s hospitals are serious about enrolling uninsured patients in some kind of insurance under the Affordable Care Act.

The plan at Cooper University Hospital is to make it as easy to sign up for coverage as possible.

Back in December, Cooper rigged up their computers so any uninsured patient who came to the hospital or ER would get a call after discharge. That’s why Edwin Vazquez is here today– he was just in and out of the ER for kidney stones.

The 21 year-old understands he can’t afford to go without insurance.

“Hopefully they give me this so I can get everything I need and not have to pay out of pocket and go to the emergency room," he says. "Because I don’t have a doctor.”

The American Hospital Association says thousands of hospitals are taking similar steps. But Cooper is not only helping Vazquez with insurance, the hospital also scheduled him for a free primary care visit. For Cooper, it’s a no-brainer; the hospital knows there’s a good chance Vazquez will come back, and a primary care visit is a whole lot cheaper than another trip to ER.

“I got hope right now," Vazquez says. "I feel blessed. I feel like they care when they sent me over here. Give me a chance. They didn’t leave me out there, [saying], OK...'you deal with everything'."

Vazquez is one of the lucky ones in the city of Camden. Since October, in the city and surrounding county, more than 9,000 people have applied for Medicaid. Shawn Sheekey, the Director of the Camden County Board of Social Services estimated about 7,000 people are still waiting. Promised technology hasn’t gotten off the ground and options are being discussed, he says, but there’s no immediate solution in sight.

“We are struggling a bit, quite frankly," he says. "It’s a lot of applications. We’ve not added staffing, and it’s presenting a problem."

“More or less, there are backlogs everywhere,” says Matt Salo, who runs the National Association of Medicaid Directors.

Salo says since the federal exchange, healthcare.gov, launched last fall, states have struggled to get the necessary information from Washington. For people trying to get Medicaid, that means delays. 

“You know there haven’t been enough staff or enough funds to pay for overtime to be able to process this backlog as quickly as we would like,” says Salo.

But there is a workaround. Salo says people must remember Medicaid coverage is retroactive. If you’re sick, he says go to the doctor, go to the hospital; get treatment. And under the Affordable Care Act, it’s now much easier for hospital to get people signed up for Medicaid.

Stan Dorn, with the Urban Institute, says there’s a simple reason why: "Hospitals get paid if their patients are put on Medicaid, if their patients are uninsured, hospitals don’t get paid."

Eventually the Medicaid backlogs are expected to clear. But until they do, Cooper’s Dr. Jeff Brenner says hospitals should go beyond signing people up.

“Knowing those are Medicaid eligible patients, it makes sense for hospitals all across the country to go the extra mile and start giving patients primary care even before the card has arrived in the mail,” he says.

Otherwise the same uninsured patient's coming in and out of the ER continues  the same old expensive and demoralizing loop. Brenner says getting uninsured patients in the door signals that a hospital cares about patients' health. Often, he says, that’s an essential first step to helping patients care about their own health.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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