Local Clinics Feel Waves of National Policy

Newly-signed healthcare legislation creates new rules, regulations and many questions

On Tuesday, March 23, President Barack Obama signed a budget reconciliation bill enacting sweeping healthcare reforms, succeeding where other commander-in-chiefs, from Clinton to Nixon to both Roosevelts, have failed.

In Clark County, where 10 percent of the population is uninsured and another 13 percent can't afford access to healthcare, according to the Clark County Public Health Dept., many patients are already encountering the effects of a brave new world in healthcare – one complete with different rules, regulations and lots of questions.

Though Jon Russell isn't a medical practitioner, as co-owner of Columbia Gorge Medical Center in Washougal with his wife, family nurse practitioner Sarah Russell, he claims to have a novel approach to healthcare. As does Dr. Rebecca Hoffman, who runs a similar clinic in Vancouver, Great West Family Care.

Where Hoffman and Russell differ most strongly however, is on the role of the federal government in healthcare, including last week's historic reform bill.

Hoffman, a primary care physician who opened her clinic in 2002, hailed the recently-enacted legislation, which she says will allow more people to seek medical help. "I became a doctor to help people, and in the end, more people will be seen," she said, a stance mirrored by the Washington State Medical Association.

Both Hoffman and Russell run clinics serving patients with Medicaid, Medicare and private insurance plans, as well as those without health insurance coverage. But unlike Hoffman at Great West Family Care, Russell is firmly against the healthcare reform bill signed by President Obama. "The federal government has no place in healthcare," said Russell, who currently serves as Washougal's mayor pro tem and is an announced Republican candidate as a state representative in the 18th Legislative district.

Hoffman's clinic operates under a model created through 2007 Washington state legislation allowing health practitioners to create a membership program for patients, wherein the uninsured can receive medical care. Approximately 8,000 uninsured across the state have taken advantage of the model so far, according to the Washington State Office of the Insurance Commissioner, and Great West began offering it in January. "Alongside our standard practice, we have this membership model practice for those with no other options," Hoffman said.

With membership, Hoffman charges a flat rate of $65 to non-insured patients or $40 for their children. This covers any in-clinic procedure, with tests and other outpatient procedures billed to the patient at cost – to be paid before services are rendered, she says.

Russell, on the other hand, has created his own type of clinic, which doesn't follow the membership model. Columbia Gorge charges $75 a visit to the uninsured, but for the first three visits they only have to pay what money they can afford. "They have to make some kind of investment into their own care," he says.

According to Russell, part of patient costs is covered by local charities, including the Salvation Army and local churches. Russell is also an advocate for an increased role for faith-based institutions in the healthcare system.

After three of these pay-as-you-can visits annually, Columbia Gorge patients are put on a payment plan to cover their own expenses – a billing practice that Russell claims builds a sense of self-reliance and pride.

However, one of the reform bill's key components, a mandate requiring most Americans to have some kind of health insurance, scheduled to take effect in 2014, is likely to dramatically change the operations at both Columbia Gorge Medical Center and Great West Family Care.

"I'm worried about the bill," said Russell. "Our unique practice catered to a certain group, and with them being forced into an inefficient program, that will be gone."

Hoffman concedes that her hybrid-practice will lose its uninsured wing, although it's a change she welcomes, since she says more people will ultimately receive care.

The bill will make a number of changes over the next 10 years. In the first six months of its passage, it will be unlawful for insurance companies to decline coverage based on pre-existing conditions for children, and the so-called "doughnut" hole in prescription drug coverage for seniors will be closed.

Within four years, all pre-existing condition exclusions will be outlawed, insurance companies will be put under stricter control and health insurance coverage will be mandatory for an estimated 95 percent of Americans – which according to Russell, sets up an unconstitutional precedent.

That's a view shared by Washington state Attorney General Rob McKenna, a Republican who announced plans last week to join a lawsuit by 13 states across the U.S. calling the mandate a violation of state rights, among other constitutional issues.

"Healthcare isn't a right, because it isn't enumerated in our constitution," Russell said.

Hoffman sees things differently. "Many things aren't specifically pointed out in the constitution, but I think the idea behind the bill is laudable either way," she said.

The Congressional Budget Office estimates that this bill will increase taxes on families making over $250,000 a year while increasing some monthly health insurance premiums by 10 to 13 percent. However, the legislation is projected to help cover an estimated 45 million Americans uninsured at any point throughout a year.

Although the bill's most striking features won't kick in for a few more years, the $940 billion healthcare overhaul has already divided many Southwest Washingtonians – not just Hoffman and Russell, who seem as opposed in their beliefs about the role of healthcare in our society, as they are similar in the way their businesses are delivering that care to uninsured patients.

"Of course, this bill is imperfect," said Hoffman. "But something had to be done to assist the millions seeking help and this is a first step in the right direction."