Health care mandate’s local effect explained

By Emily Ballard

Texans only have a few more days to sign up for health insurance under the Affordable Care Act. March 31 marks the deadline, as stated on Diversity in medical needs and income levels complicates President Barack Obama’s goal of ensuring affordable health care to all Americans.

Dr. Lauren Barron is a family practitioner, clinical professor and associate director of the medical humanities program at Baylor. In between juggling these three time-consuming jobs, she shared her insight and observations of the Affordable Care Act’s effects on health care in Waco. Barron works at the Family Health Clinic in Waco, which serves 50,000 underprivileged patients, she said.

She acknowledged the complications of the health care system and the need for improvement in the way health care is delivered to underprivileged Americans.

“It really couldn’t get any worse out there for a vast part of our society that gets forgotten about,” she said. “It very well may be that it’s an inconvenience to many Americans and an irritation, but it is a lifeline for a huge portion of our community.”

Barron believes wholeheartedly in the vision of a primary care-centered health care system. She said she agrees with Waco physician Burritt W. Hess who told Baylor students in a presentation at Baylor that “the Affordable Care Act placed primary care at the center of a restructured United States health care system that has the potential to provide world class, cost-effective care on an individual and population based level.”

Q: How do patients’ eligibility for reduced cost of medical insurance under the ACA affect physicians’ pay for the care they give?

A: The patients are more likely to get care if they qualify for exemptions. For many clinics, we expect more patients to come in for care, so that translates to more revenue for a clinic.

Q: How do physicians in McLennan County keep track of the 70 different health insurance plans in the county?

A: That’s absolutely absurd and impossible. No physician I know can be an expert on all of that because it’s far too complicated. It’s impossible for physicians to keep up but that doesn’t mean someone in the office isn’t responsible for doing that.

Q: Do you think the ACA makes quality health care more or less available for students? How so?

A: Well, you’re allowed to stay on the insurance plan of your parents until you’re 26. The demographic of most Baylor students is that they are on their parents’ insurance plan. There are other students who fall through the cracks. They’re not going to have to pay a penalty because they don’t make enough money to pay for insurance.
The next step would be Medicaid. But just because you qualify for Medicaid on paper doesn’t mean you’re going to get it because it’s so restricted right now. Texas did not expend the Medicaid program.

Q: What would you change about the ACA if you had the power to do so?

A: I think the idea of 70 different companies is too complex. I think somehow that ought to be consolidated. Even though I want to pay attention to costs for my patients, I can’t get clear answers about costs. I can write a prescription for 10 different people of the same medication and it would be 10 different prices. We need transparency in costs. And Texas should have expanded the Medicaid.

Q: Which parts of the ACA do you agree with?

A: I agree that health care should be affordable. I’m impressed with the outreach that is being done to try to help people sign up. I think we could communicate better. I think there are whole segments of the people who aren’t going to sign up online. Latinos want a personal relationship. Certain educated, elite, white, privileged people are OK online but there are many people in our society are not as comfortable online.

Q: As a physician, how, if at all, has the ACA affected the quality of health care you feel you can give your patients?

A: It has improved. One of the reasons I think it’s improving is because there’s being pressure exerted because of the way the U.S. health care reform is working. It incentivizes good primary care. There’s a lot of complexity and confusion and yet there’s also a lot of opportunity for really good things to happen in the health care system.

Q: Do you predict a greater need for doctors in the Waco area in the near future? If so, what kind of doctors?

A: You don’t even know. There’s a huge primary care shortage, and it’s not being addressed.

Q: How should physicians approach medicine differently now that the health care system has changed?

A: I strongly believe part of the solution to the primary care shortage is we’ve got to start creating primary care physicians before the walk into medical school the first day. We’ve got to help shape their opinion about primary care because in the medical schools, the desire to go into primary care gets beat out of you. It’s all about the specialists. The natural habitat of a family physician is not a major medical center. It is a town like Waco, Texas.

Q: Were you discouraged from becoming a family practitioner?

A: In medical school when I said I was going to go into family medicine, I had a doctor say to me, “You’re an idiot and you’ll always be a second-class citizen.” I was stunned, but in retrospect he did me a favor. He captured in one sentence the attitude that prevails in medical schools. Primary care does not get a very good rep. Some of it is about money; some of it is about prestige.

Q: What words of advice do you offer your pre-med students for navigating the ACA?

A: I am convinced that giving these pre-med and pre-health students positive exposure to family doctors — even if they don’t go into family care — will immunize them against this bias against primary care. This is about caring for a huge part of our community. The ACA is not perfect, but I have tremendous admiration for the courage it took for lawmakers to finally get sometime done to start a conversation for a solution.