Dozens of patients in need of low-cost medical care fill the waiting rooms of Franklin’s WindRose Health Network clinic.
They come to see a doctor about a lingering cough, upset stomach or other malady. They receive medication to help control heart conditions, get insulin shots to manage diabetes and are given direction if they need to be referred to a specialist for more thorough treatment.
In the past few years, an increasing number of WindRose patients are coming in with some kind of insurance, many from the Healthy Indiana Plan, a state program that offers affordable coverage to adults, according to CEO Michael Kolenda.
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But even with an improving economy and more coverage being offered through government programs, people are still dealing with having no insurance or not enough coverage.
“We have a percentage of patients who have a job, but they aren’t covered because they can’t afford insurance,” Kolenda said. “These plans are a good start, but we still have an issue with the poor getting health care.”
More than 90 percent of people living in Johnson County have health insurance. According to the U.S. Census Bureau, the uninsured rate is the lowest it has been in the county in at least six years, having steadily decreased from about 13 percent in 2010 to 8 percent now.
But with most of those without insurance still struggling with poverty and unemployment, local health advocates insist there is more that can be done to provide coverage to all.
“We’re trying to work together to make sure that everyone has coverage, everyone has care, and everyone can get the preventative care they need,” said Peggy Homeier, director of operations for St. Francis Health Network. “We have the wrong people going to the emergency room. If we can get them in the primary care office, they’ll be healthier and more engaged with their own health.”
Throughout the country, the number of people with insurance coverage increased in 2014, according to the Census. All 50 states and Washington, D.C, reported more people with insurance last year compared with 2013.
Part of that stems from the Patient Protection and Affordable Care Act, more commonly known as Obamacare, which went live last year. An estimated 16.4 million people enrolled nationwide who had not had coverage before.
In Indiana, the uninsured rate hovered around 14 percent of the total population in 2013 and dropped to 11 percent last year.
Those numbers likely will decrease this year and in the future, said Jim Gavin, spokesman for the Family and Social Services Administration, which oversees the Healthy Indiana Plan.
In February, the state unveiled Healthy Indiana Plan 2.0, an affordable insurance program for low-income residents. People ages 19 to 64 qualify whose incomes are 138 percent or less of the federal poverty level.
Since registration started, more than 3,400 Johnson County residents have enrolled for insurance coverage.
In addition, 5,327 people out of an eligible 11,000 county residents signed up for MDwise Marketplace, the federal government’s low-cost insurance program in Indiana.
“You can see where (Healthy Indiana Plan 2.0) had eaten into that number of uninsured. It’s not all the way there, but it’s eaten into it,” Gavin said.
Franciscan St. Francis Health launched a series of 10 informational events and sign-ups to get people enrolled in the state program. Officials helped answer questions and determine if a person was eligible for coverage under the plan.
Staff members at the hospital work with patients who come in for treatment and help them get coverage immediately if they qualify, Homeier said.
Enrolling as many people as possible will have benefits not just for the patient but also for the health care network. Fewer people will use the emergency room as their primary source of health care, and people may be more motivated to consider their health more regularly.
“When a person doesn’t have insurance, they have a lot of pent-up demand. They’re not going to the doctor like they should. They may let chronic conditions exacerbate until they’re a big problem,” Homeier said.
The new programs and the improving economy have helped lower the uninsured rates in the county. But gaps remain.
WindRose, a group of community health centers based in Franklin, Trafalgar, Hope and the southside, is seeing firsthand the changing dynamics of the uninsured. Care at the centers is offered on a sliding-scale fee schedule, with people in lower income brackets paying less.
“Since they started (Healthy Indiana Plan), that message is getting out to people, and more people are applying for it,” said Robin Musial, a registered nurse and office manager of WindRose’s Franklin office. “But we’re still seeing sliding-scale fee people who have no insurance at all.”
Because of programs such as the Healthy Indiana Plan, patients at the lowest end of the poverty spectrum are receiving coverage, which is a good thing, Musial said.
But the plan is available only to people earning under a certain amount. For example, any individual making $16,436 or less per year would meet the requirements. A family of four whose household income was $33,865 or less could sign up.
That leaves a large gap of people who make too much each year to qualify for the program but do not make enough to afford insurance through their employer or on their own, Kolenda said.
Unemployment is down in Indiana, reaching 4.6 percent last month. But in 2014, people living in poverty rose to 15.4 percent of the population, according to Census data.
“Maybe it’s not jobs, it’s what kind of jobs and what they pay,” Kolenda said. “That’s kind of the dirty little secret. Part of poverty is having enough money to pay for things that are life-sustaining — do people have enough to live on.”
Windrose is treating a number of individuals and families whose median income is in the $40,000 to $60,000 range but who can’t afford insurance on their own.
“The lower-middle and middle class is being squeezed out of this, unless they can afford whatever their employer can give them,” Kolenda said. “That is not going away, despite all of these plans. They’re still not addressing that.”