Newly insured begin to receive care

Certified application counselor Eric N. Goren has spent the last five months helping people negotiate the often-perplexing path to buying health insurance on the Affordable Care marketplace.

And primary care doctor Eric N. Goren is beginning to see the results of his efforts at a clinic in West Philadelphia.

"I've started to see a small number of folks who are now insured," said Goren, an assistant professor at the University of Pennsylvania.

One thing the ACA hasn't changed is the lag time between calling for and scheduling an appointment. It still takes a few weeks, and most physicians have yet to see a steady flow of the newly insured. On the whole, the new patients he sees are no sicker nor are their problems more complex than those he sees at Penn.

But two new groups are emerging. The first, young adults in their late teens and early 20s, don't have pressing medical problems. Most just need basic care that, before the ACA, they would have sought in an emergency room.

The other group - what Goren calls "the real bread and butter of primary care" - are older people who have, or are at risk for, high blood pressure and diabetes. They are also the people who earn a little too much for Medicaid or not enough for private insurance.

"What we have been seeing, what we kind of predicted, is this middle ground of folks that are part-time employed, have a little bit of income, are still working but don't qualify for medical assistance," Goren said. "They have a couple of conditions that aren't that hard to manage but made their [old] insurance policies ridiculously expensive."

Antoinette McMillan, 43, of West Philadelphia, was one of those people. She lost her job as a legal secretary a few years back and has been working through an agency that doesn't offer insurance. She has high blood pressure and couldn't afford coverage on the individual market.

She was using a clinic in the basement of the First African Presbyterian Church in West Philadelphia to monitor her blood pressure and overall health. The clinic, sponsored by Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania, is run by Goren and staffed by Penn medical students, some of whom are trained as certified application counselors.

"The care and quality you get from them just overrides the fact that it's in the basement of a church," McMillan said. "They are very good medical providers, the doctors as well as the students. They are very professional and very thorough."

When the ACA marketplace opened for business Oct. 1, McMillan was ready to seize the opportunity for insurance. But like thousands of others, her attempts were stymied by the balky healthcare.gov website.

"I told Dr. Goren about it and the staff members helped me in getting through the process," she said. "I was able to sign up with their help."

McMillan chose a policy from Independence Blue Cross, and a subsidy lowered her monthly premium to 16 cents. She has found a primary care physician who is monitoring her blood pressure.

"Not having that worry and that pressure is awesome," McMillan said. "We need this type of medical coverage for our citizens. The other option without Obamacare is to go on welfare. Nobody wants to be on welfare if they don't have to."

Goren believes his colleagues won't feel the full effect of new patients until June. By then, everyone who signed up by the March 31 deadline will have started coverage.

That expected influx raises the question of who will care for them, as there is already a shortage of primary care physicians. Goren acknowledges that until the medical establishment catches up with demand, a few bumpy years lie ahead. Meanwhile, there are patients who need to be seen.

Having enough primary caregivers will take a few years, he said. "But to not address 30 million folks who didn't have coverage because we are afraid of the demand it is going to have on clinicians seems to be very short-sighted and goes against what we are here to do. And that is to take care of patients."

215-836-0101