by: Maggie Amjad

This is the fourth installment of my Service Learning Capstone project on Healthcare in the US. The first article examined the history of healthcare in the United States and the second covered the Affordable Care act. Throughout the Spring, the rest of findings will be published on HB in Retrospect. This post focuses on interviews through a google form with healthcare professionals and volunteers in Cleveland. Look for my final post detailing my experiences working on this project!

I first reached out to Ellie Felderman, a fellow HB senior. As a volunteer at Planned Parenthood, Ellie brought a very interesting perspective to my research. She shared that Planned Parenthood only charges fees based on what people are able to afford. Additionally, without the Affordable Care Act and Title X, Planned Parenthood would virtually have no funding. The organization also acts as a manner for people to access insurance and gian information around it. With Trump’s plans and budget cuts, Planned Parenthood is at risk of closing.The largest controversy around Planned Parenthood is the access it provides to abortions. This is the most prominent argument for cutting off funding and closing Planned Parenthood. Ellie shared that no government funding is directly used for operations and that abortions only make up 1% of the activities of Planned Parenthood. Closing all of these clinics will only hurt those with limited access to healthcare. In her experiences at Planned Parenthood, Ellie has found that while the Affordable Care Act has it problems, it is very effective in providing healthcare and managing patients.   

I also was able to talk with a Susan Mego, an executive director at MetroHealth. She shared that her years in the health service industry have taught her that Healthcare in the United States is constantly evolving. The Affordable Care Act brought changes specifically expanded the reach of insurance and now new proposed legislation will continue to change the field if it passes. Susan has watched her own field transform under health care changes. She shared that the healthcare market is constantly changing and therefore the pool of patients they reach changes as well. If many lose their healthcare as a result of the American Health Care Act, it will decrease the amount doctors visits and professional consultation nationally. The hardest part of having an unstable health care field is that no one can predict the impact of new changes. Susan noted it can take up to five years to really see the impacts. Additionally, the polarizing political debate around healthcare serves as a block to much of the progress that needs to happen.

Finally, I reached out to Lauren Barbour, a program manager for Medworks, a Cleveland based non-profit which provides the underserved with free medical clinics. The largest shift Medworks has experienced as a result of the Affordable Care Act is seeing uninsured people versus seeing underinsured people. Lauren shared that the underinsured typically have a form a basic insurance but lack an understanding of how the system works and how to access the medical care they need. As a result, registering those eligible Medicaid has become one of Medwork’s most popular services. Like Susan, Lauren is very unsure of how new legislation will impact health care in the US. She is most concerned about the population that has just received insurance in the expansion of medicaid that would return to being uninsured. No matter what happens, Lauren is confident that Medworks will continue serving the needs of the community. The Affordable Care Act has allowed the non-profit to decrease their general medical clinics, but a need for vision and dental services has continued to increase. A repeal of the Affordable Care Act most likely would result in an increase to the population Medworks serves.

Each of these women have engaged in the health service industry in a different way, and each of them are making a massive difference in our city. There is so much to learn from each of their experiences in the industry. Ellie serves as a great example of how to get involved at a young age and make a real difference. Susan on the other hand, took a more traditional route through working in a hospital. Lauren is able to serve an entirely different population through Medworks. One of the most interesting parts of Medworks is that it is primarily volunteer based. It is a great opportunity to get involved in healthcare at a young age and have a positive impact on our community.



Ellie Felderman
Susan Mego
Lauren Barbour
Student 🙂 & peer educator through Planned Parenthood
Executive Director – Managed Care
Program Manager – Non-Profit
How has the Affordable Care Act impacted you professionally and the overall healthcare system? Do you think these changes have been for the better? 
       The Affordable Care Act is incredibly important. There’s little to no way that low-income individuals can get access to critical healthcare without it. Somebody who makes $15,800/yr (the requirements as of 2014) Is most certainly not getting healthcare through their employer, and cannot afford it on their own. Out-of-pocket expenses are impossibly high without the Affordable Care Act.
        The creation of the ACA along with its ongoing evolution and repeal attempts have directly changed the way some consumers purchase insurance coverage and seek healthcare. This especially caused new access to affordable healthcare for those who don’t qualify for Medicaid yet aren’t covered by an employer’s group insurance. With it came a new stream of product designs and insurance companies offering them, some entering the market hesitantly and others leaving it after regret. The thinning of the ACA Healthplan pack may allow those organizations that remained to grow enrollment and achieve more sound actuarial financial outcomes than in the past. It also allowed providers of care to move some formerly uninsured self-pay patients into insured status, though patients needed to continue to pay their monthly premiums to retain that coverage. It likewise caused some unique competitive contract negotiations and new roles in the insurance industry.
        Prior to the ACA, Medworks primarily served uninsured patients but with the ACA we see many more patients that we would qualify as underinsured. These are patients with some type of insurance but not enough coverage and/or an understanding of the medical system to access care. Many of the gaps we see fall in the areas of specialty services including medical and dental. For many of the uninsured patients who attend a Medworks clinic we are able to connect them with services that they may not be aware are available to them. Often times they are eligible for medicaid and we can enroll them in coverage right away.
How has the recent controversy in Congress over healthcare specifically the proposed repeal of the Affordable Care Act impacted your profession/organization? 
        Planned Parenthood’s fees work on a sliding scale. Based off how much someone makes, they get charged accordingly for their healthcare service. Outside of private funding, Planned Parenthood gets the majority of our money from the Affordable Care Act and Title X funding. A person comes to Planned Parenthood, and if they qualify for ACA or Title X funding aid, it’s registered after their visit.
        Among other things, it caused another ripple in an already unstable industry and generated push-pull effect for small companies deciding whether to offer group insurance or fund limited healthcare accounts for their employees to spend on the marketplace exchange. That uncertainty, in turn, helped fuel unique market solutions whereby provider-owned networks are now directly-contracting with employers for deeply discounted access to coordinated healthcare, offering direct primary care prepaid plans to make healthcare affordable to individuals, etc. This provided my profession new avenues of product development, network enrichment, and patient retention.
        It is mainly wait and see as I believe no one is quite sure of how these proposed changes will effect those currently insured. I think the biggest concern is for the population that falls under the expanded medicaid umbrella. If expanded medicaid goes away or the subsidies are removed we will have a huge number of people who immediately lose their coverage and now become charity care for the hospital systems.
How will your organization change if healthcare moves in the direction President Trump has proposed in the American Healthcare Act? How will it change for your clients?
        Without ACA or Title X, Planned Parenthood wouldn’t be able to serve the vast majority of our clients. Many people who visit are low-income and in need of healthcare services, and PP would never be able to cover all of these costs without ACA and Title X. If ACA were to disappear, a significant amount of people would be forced to go without critical care.
        Similar to past introduction of controversial health care related Acts. Many of the approaches introduced by these Acts need much more time to show ROI than the 4-year presenting election cycle allows so rarely come to fruition in s pure sense.
        Medworks will continue to serve the needs of the community. With the ACA we saw a decrease in the need for some of our general medical and women’s health services. However, the need for specialty services, including vision and dental, continued to grow. We were able to respond to this need and increase our capacity in both of these service areas. With a repeal or major changes to the ACA, we anticipate a higher demand for all services including medical, women’s health, vision and dental.
In your experience, do you think the current Healthcare system in the US is effective? Why or why not? 
        I think it’s better than what Trump wants to do with it, but it could definitely use improvement. Every couple of years (3, I think), PP has to re-apply for Title X funding through a rigorous and exhaustive system. Title X funding covers so much of what PP is able to do for its low-income patients and families. We also have to fight the abortion fight nearly every day in some way. No government funding aid is used for abortions, and abortions account for less than 1% of what we do. Our job is to keep people healthy and safe, and there’s a huge fight to defund us entirely. Healthcare needs to be more widely accessible, not just through PP, but for everyone. Not everyone can afford it, not everyone makes a congressman’s salary, not everyone has access to it, but it’s necessary for everyone.
        The fact that the current healthcare system is constantly challenged, often in flux, and an ongoing politic debate is evidence of its less-than-desirable effectiveness. There are many more influencers and stakeholders in the health care buying process than most folks realize, frequently with contradictory objectives. The industry has made significant strides in shifting the managed care power from insurers to providers which allowed for new reimbursement methodologies that pay for value not just pay for service.
       I think we are moving in the right direction but there is still much work to be done. Screening and preventative care need to be prioritized as they are our best tools to detect and treat disease earlier. However, I believe the healthcare system in general is overly complicated and steps need to be taken to remove barriers to care. For example, the expansion of the Federally Qualified Health Centers has allowed for more community focused care. This has allowed people who may have been unable or unsure of how to access care through one of the large hospital systems, to still receive services.
Do you think socialized healthcare would be more effective? Why or why not?
        Socialized healthcare would do wonders for people who don’t have access to reliable healthcare right now. It would be no doubt difficult to integrate into our economy, government, politics, etc., but it would give everybody healthcare. Everyone! We would all be able to see doctors when we need to, we would all have an equal opportunity to be healthy. Health shouldn’t be a privilege as it is now; it should be a right.
        Some advantages could be that socialized health care and medications would be affordable to all patients and offer insurance for even complex medical needs. In contrast, the consequences could be that individuals may not be equipped with sufficient info to make wise health care decisions, and capacity issues may cause long waits for care. Its acceptance in the current of U.S. market and its economic curves would prove difficult.
        Yes. I believe making healthcare accessible to everyone would provide the best results for the largest amount of the population. By limiting access to care we are only prolonging diagnoses and treatment which ends up costing more money in the long run.
Other Articles:
Posted by:hbinretrospect

Reporting not for school, but for life.

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