When a patient walks into Hunter Health Clinic in Wichita for an appointment, staff might ask them a variety of questions about their living situation: how much food someone has at home, if they’ve recently lost a job or if anyone in their household is struggling with addiction or their mental health.
The screening process is meant to determine someone’s social determinants of health, or conditions in their environment that could have an impact on their health. Lately, the clinic has seen an increase in people seeking care who’ve lost their health insurance after a layoff.
For some Wichita families, one working person’s layoff could result in a variety of canceled appointments. It could be simply missing an annual check-up. But sometimes, the loss of health insurance could mean losing out on a much-needed counseling session or skipping necessary surgery or medications.
Thousands of Kansans lost their health insurance this year as the coronavirus pandemic caused job losses to sweep the state. Many could struggle to find affordable care in a state that hasn’t expanded Medicaid.
Hunter Health often serves people who are uninsured and underinsured. This year, they’re seeing patients who haven’t had to visit the clinic before.
“Now we see more middle class people, who were fine before, but now had a sudden loss of income,” said Kaitlin Boger, director of integrated care at Hunter Health. “Whereas typically we serve more low-income folks or people without a home. It’s a totally different population.”
Guadalupe Clinic also serves people who don’t have access to or can’t afford insurance. It’s the only completely free clinic in town, said executive director J.V. Johnston. It asks for a small donation if someone is able to contribute. That clinic, too, has seen an increase in patients seeking care because they experienced a layoff and loss of health insurance.
Around 43,000 people in Kansas became uninsured due to a job loss between February and May this year, according to a report from The National Center for Coverage Innovation at Families USA, a nonpartisan organization that advocates for health care consumers. That’s a 20% increase from the number of uninsured adults in the state in 2018.
Overall, about 15% of all adults in Kansas were uninsured as of May this year, according to the report.
“People don’t generally think about health care until they need it,” said Tammi Alonzo, assistant nursing director at Guadalupe Clinic.
Health care system stressed
Guadalupe Clinic recently hired a new physician’s assistant as the provider anticipated a surge in people without insurance seeking care, said Johnston. Since services are free for patients, most of the doctors at Guadalupe are volunteers, and some decided to stay home over worries about contracting COVID-19. The new position will allow them to serve more patients and decrease appointment wait times.
A range of specialist services, including dermatology, are offered at Guadalupe. This fall, they saw an increased need for even basic services. At a flu shot drive-through site they hosted last month with the KU School of Pharmacy-Wichita, they vaccinated nearly twice the number of people as in 2019. Health officials have urged everyone to get their flu shot this year as symptoms overlap with those for COVID-19.
Hunter Health also added a new staff member to assist with dental appointments, said CEO Amy Feimer. Hunter is a federally-backed facility intended for low-income patients and offers sliding scale fees.
At Hunter, patients can access a range of care options: medical, dental, vision, behavioral health, pharmacy, nutrition and more. They can also help navigate Medicaid for those who are new to it.
Lately, Hunter Health has seen about 15 more people per month than usual who need assistance with the health insurance marketplace.
“I think COVID has shined a light on how complicated our health care system is,” Feimer said. “It’s not a new issue, but we’re seeing the system stressed now.”
Impact of Medicaid expansion on uninsured
Some laid-off workers who lose their health insurance are not eligible for Medicaid coverage without an expansion of the program. In Kansas, Medicaid is limited to pregnant women, people with disabilities, people over 65 and very-low-income families with children.
In January, Kansas had a bipartisan plan to expand Medicaid. However, the deal collapsed in May, leaving the possibility of expansion to next year’s legislative session. Extending the state’s program would have covered an estimated 130,000 uninsured Kansans.
If Kansas had expanded Medicaid, some people who lost their employer’s insurance would become eligible for Medicaid rather than falling into the coverage gap, according to a report from the Kaiser Family Foundation, a nonprofit and nonpartisan organization that analyzes national health issues.
States have the option to expand Medicaid under the Affordable Care Act, or “Obamacare.” States pay 10% of the cost with the federal government covering the rest.
Kansas is one of 12 states that has not adopted the expansion, after neighboring Missouri and Oklahoma recently voted to extend coverage.
As the Supreme Court considers a constitutional challenge to the ACA, it could potentially put expansion at risk even in states that have already voted for it. Justices heard oral arguments in the case on Tuesday, but indicated the bulk of “Obamacare” would likely survive.
While lack of access to coverage can leave many uninsured in a year with large job losses, it’s not always the primary reason. Nationally, the majority of uninsured adults in 2019 weren’t covered because they said health insurance was unaffordable, even if they had access to it, according to the Kaiser Family Foundation.
Other states turned to different solutions. In Michigan, where the number of uninsured adults rose 46% from February to May, Gov. Gretchen Whitmer announced the state would use CARES Act funding to aid community organizations that help people enroll in insurance, the Detroit Free Press reported.
True consequences yet to be seen
The patient volume at Hunter Health is somewhat steady compared to last year, said Feimer. However, approaching the end of the year, the clinic has about the same amount of patients in 2020 so far as it did at this time in 2019, despite seeing a huge dropoff of visitors in March and April during the stay-at-home order.
“We’ve been extremely busy the last two months,” Feimer said.
Hunter Health saw more people who lost their insurance in May, June and July than in March or April, said Boger, the integrated care director. That’s in the time period after the Families USA report on the number of uninsured in Kansas.
If a two-income household loses one job, some people might choose to go without insurance even if the other person’s employer offers coverage for the rest of the family, Johnston said.
“You have to pay more for that other spouse’s insurance still,” said Johnston. “Food and rent usually come first for people, before insurance costs.”
Alonzo, at Guadalupe Clinic, also noted that the clinic is seeing more patients with anxiety concerns during the pandemic. It has a counselor come in twice a week for individual sessions that can take place in either English or Spanish.
Feimer, with Hunter Health, thinks Wichita has seen only the tip of the iceberg when it comes to the amount of uninsured and underinsured people seeking care. She thinks past programs such as the Paycheck Protection Program helped keep people employed in the short term. Other aid from the CARES Act, like stimulus checks and expanded unemployment benefits, also helped keep families afloat, Feimer said.
Now many of those relief programs have expired, but layoffs continue.
“I think a lot hasn’t boiled to the surface yet,” Feimer said. “I can’t help but worry we have more impact yet to see, especially going into the winter.”
How to get help
Open enrollment under the Affordable Care Act is ongoing. If you’re eligible, apply and enroll by Dec. 15 for a coverage plan that will begin on Jan. 1, 2021. Visit healthcare.gov/get-coverage to look for options in Kansas.
Free or sliding-scale clinics in the Wichita area:
Guadalupe Main Clinic:
- 940 S. St. Francis
Guadalupe South Clinic:
- 2825 S. Hillside
- Hunter Health Central Clinic: 527 N. Grove
- Hunter Health Brookside Clinic: 2750 S. Roosevelt
- Hunter Health Interfaith Ministries: 935 N. Market
GraceMed Wichita clinics:
- GraceMed, Dodge Family Clinic: 4910 W. First St.
- GraceMed, Evergreen Family Clinic: 1125 W. 26th St. North
- GraceMed, ComCare: 1919 N. Amidon, Suite 100
- GraceMed, Helen Galloway Clinic: 1122 N. Topeka
- GraceMed, Meyer Family Clinic: 755 W. Lincoln
- GraceMed, Oaklawn Family Clinic: 5000 S. Clifton, Suite 200
- GraceMed, Downing Family Clinic: 2201 E. 25th St. North, Bldg. 200
- GraceMed, Good Samaritan Clinic: 3701 E. 13th St.
- GraceMed, Healthy Family Clinic: 1905 S. Laura
- GraceMed, Jardine Family Clinic: 3610 E. Ross Parkway
- GraceMed, Mother Mary Anne Clinic: 1131 S. Clifton
- GraceMed, Virginia & George Ablah Family Clinic: 3417 S. Meridian