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Affordable Care Act ‘Bridge’ Programs Bring Relief to the Uninsured
Self-diagnosis, followed by a run to the local drugstore to buy over-the-counter medications, was for years all Lupé Yarrito could afford because the mother of four always found herself making “a couple of dollars” more than the maximum to qualify for Medi-Cal, the federal-state-funded health safety net for the poor.
Yarrito’s part-time jobs did not provide health insurance, and paying out of pocket to see a doctor just never felt like an option. “In our culture, we’d rather put food on the table with the dollars we earn than spend that money to go see a doctor,” said Yarrito, who is of Mexican descent and depends on food stamps.
That all changed last January, when the then 51-year-old applied for San Bernardino County’s Medically Indigent Adults (MIA) program, and was automatically enrolled in a new low-income health program, ArrowCare, that the county had just launched as a replacement to its MIA program.
ArrowCare was designed to be a “bridge” to Medi-Cal (called Medicaid in the rest of the nation) for uninsured low-income people like Yarrito, who had previously been ineligible to receive state health benefits. The logic goes that Yarrito and others enrolled in ArrowCare will eventually be enrolled in Medi-Cal, when that program expands in 2014 with the full implementation of the Affordable Care Act (ACA), the Obama Administration’s landmark federal health care law.
All but a handful of California’s 58 counties opted to launch bridge programs similar to ArrowCare, under the federal Low Income Health Program (LIHP) that is a part of the ACA. The program allows counties to provide health care to their uninsured in a more efficient and less expensive manner, because they’re not on the hook for the whole cost -- the federal government and the county have a 50-50 funding agreement.
Each county has its own name for the LIHP program – in San Bernardino it is called ArrowCare; in Alameda, it is called HealthPAC and in Los Angeles County it is called Healthy Way LA.
In addition to offering a bridge to coverage under Medi-Cal, ArrowCare offers some desirable features that the MIA program did not have, including: no co-payments, no cap on emergency room services and access to mental health services.
ArrowCare has also reduced wait times at emergency rooms, as a result of less uninsured patients using the emergency room in lieu of a primary care physician, observed Ron Boatman, the assistant hospital administrator at Arrowhead Regional Medical Center, the county’s only hospital and a member of the ArrowCare network. The medical center offers preventive medicine, mental health services, a pharmacy and hospitalization.
ArrowCare currently has a 30-member network of providers in place, and the list is growing. “We keep proposals open to add more,” into the network, noted Boatman.
Encompassing nearly 21,000 square miles of Southern California’s inland empire, San Bernardino is the largest county in the nation and has the highest number of uninsured, Boatman said. It’s also one of the unhealthiest: the Riverside-San Bernardino metropolitan area is the fourth-most obese place in the nation, and has high rates of diabetes and heart disease, according to UCLA’s California Health Interview Survey (CHIS).
San Bernardino County has a population exceeding 2 million, and is home to roughly 97,000 people who are living below the federal poverty level (FPL) which, for the county, translates to an income of $931 a year for an individual, or $15, 132 for a couple. Boatman said that around 64,000 currently uninsured residents could qualify for ArrowCare, and it would cost the county around $64 million a year if they all enrolled.
Of the nearly 25,000 currently on ArrowCare’s rolls, half are white, nearly a quarter are Hispanic, 16 percent are black, and 1 percent are Asian. Nine percent are categorized as “other.”
To qualify for coverage, a person must fall between the ages of 19 and 64, be a resident of San Bernardino County and have an income at or below the FPL.
Since the LIHP program is only for legal residents, the county’s undocumented population – a group estimated to be 29 percent of the total populace -- cannot enroll.
For Yarrito, who said she has been feeling “weak and sick” for quite a while, enrollment in the new health program couldn’t have come at a more opportune time.
Soon after being enrolled, she went to the Metropolitan Family Medical Clinic, one of the providers in the ArrowCare network, where she underwent a series of tests. Doctors there told her she had diabetes, high blood pressure and high cholesterol.
“Thank god I qualified for ArrowCare,” said Yarrito, who will be graduating from Cal State San Bernardino next December with a dual degree in sociology and social work, with a minor in Chicano studies. “Now I see a doctor every two months. I’m taking care of myself now and feeling a lot better,” she said.
“Each time I refill my prescription at the Arrowhead Medical Health Center’s pharmacy I could easily end up spending $500. But now, it’s all free.”