File photo.

In recognition of National Family Health Month, members of several West Side-based health care providers convened a discussion regarding the state of health in Austin and surrounding communities.  

The event, which was held Nov. 19 at Austin Town Hall, 5610 W. Lake St., and was hosted by Athena Williams, project manager for Performing Community Solutions. It allowed providers to meet residents and community activists to discuss where Austin stands in the years following the passage of the Affordable Care Act (ACA).

Organizers chose to look at the positive impact of the Affordable Care Act (ACA). They lauded the act’s expansion of Medicaid and its creation of insurance exchanges to provide better competition in the market. But they said that access to health care needs to be expanded even more in underserved communities like Austin.

“The ACA works in many different ways, but for those who already had insurance it provided new protections and rules for insurance companies,” said Barbara Otto, Chief Executive Officer of the Health & Disability Advocates (HDA).

“One of the changes made was requiring all health care plans to have what are called “essential health benefits.” These are benefits that all insurance providers must have whether they were obtained through the marketplace or through the recipient’s employer. For those who were without insurance, it provided financial help to get health insurance.

Among the ten “essential health benefits” are emergency services, maternity & newborn care, laboratory services and hospital visits, which Otto adds are now provided without a co-pay if the patient is seeking a regular checkup that does not require more elaborate treatment.

“Believe it or not, the physicians haven’t caught on to this yet,” said Otto.

“I took my daughter for a wellness visit three weeks ago and I received a bill in the mail for the appointment and I said, ‘no’ this was a wellness visit and you cannot charge a co-pay for preventative care unless an illness was identified that requires further coverage. So it is very important that patients know this.”

Otto also emphasized the importance of recognizing enrollment dates and how they will impact recipients when coverage begins on the plan they sign-up for through the exchanges.

For example, if patients enroll between Nov. 1 through Dec. 15 this year, their coverage will begin on Jan. 1, 2016. If they enroll between Dec.16 through Jan. 15, 2016, their coverage will start on Feb. 1, 2016. And if they sign up between Jan. 16 through Jan. 31, 2016, their coverage starts on March 1, 2016.

These dates are significant, according to Otto, because many residents who have already registered in the past may have to re-register depending upon the terms of their policies.

“Open enrollment is from Jan. 16 through Jan. 31, 2016 if anyone is interested,” said Otto.

One of the major concerns among participants was what to do about the individuals who still refuse to enroll and are still uninsured, despite the elaborate enrollment efforts by providers.

According to HDA, the Chicago-West part of the state — which makes up Austin, Belmont Cragin and Montclare — ranks fourth in terms of uninsured residents who are marketplace eligible. Additionally, 175,000 of the working poor are still uninsured in the Chicago-land area.

“Somebody asked me the question, ‘Why are we so low in registration?’ There are people who look like us who are oblivious to what health care means to them,” said Cook County Commissioner Robert Steele (2nd).

“They are between the ages of 18 and 35. They have no idea, because they are healthy and they have no reason to go to the doctor right now. But when they turn 36, things start ticking differently. I am a witness to that. When I was told I had diabetes, I just continued doing what I was doing. When I turned 40, the doctor pulled me aside and showed me the damage that it was doing to my body. This was because I didn’t prevent this from happening before it progressed,” he said.

“That’s what healthcare is. It’s not just addressing illnesses when they occur, it’s about preventing them before they occur.”

Some of the reasons cited for the hesitation about enrollment, according to data provided by the Department of Health & Human Services, include:

  • Residents are worried about losing already existing benefits if they are found to have applied for the Medicaid expansion.
  • Residents may not speak English as a first language, so they may not fully understand the ramifications of signing up or believe that if they were to sign up, it may compromise their citizenship.
  • People are working, but feel as though their income makes them unqualified to receive benefits.

Steele added that the outreach efforts have shown to be highly successful are the ones in which time and energy are invested to create greater awareness. He said that this level of sustained commitment to educating people about enrollment, particularly in underserved areas, can result in individuals signing up for the marketplace at the level they have signed up for Medicaid expansion, which is currently at 620,000.

Karriem Watson, administrator of community engaged research at the University of Illinois Cancer Center, has his own theory about why some community members have avoided signing up.

“One of the reasons so many people are not signed up is that you don’t have that navigator. You don’t have someone in the community, where the need is the greatest, navigating people through the application.”

Watson suggested that residents become more vocal in calling for a greater number of certified application counselors on the West Side to better assist residents through the sometimes lengthy process of signing up.

“They are certified and prepared to help with any questions you may have,” Watson said.

Watson ended the event by posting an alarming slide regarding Cancer Incident Rates on the West Side.

In Austin, the mortality rate for prostate cancer is 71 percent. Nationally, it is only 23.5 percent and 24.3 percent in the state. In North Lawndale, the rate is 49.9 percent.

“All the more reason for community residents to become involved with helping members of their community get enrolled and receive preventative services,” said Watson. “These numbers do not have to be the last word on health care on the West Side.”