After the Patient Protection and Affordable Care Act ("PPACA") was signed into law in March 2013, Cook County was given permission to expand its Medicaid program. [1] The State of Illinois and the Cook County Health and Hospitals Systems ("CCHHS") began providing coverage in February 2013, catering to residents 19-64 years old with an income below 133% of the federal poverty income. [2] Currently, over 87,000 Cook County residents are covered under the new Medicaid expansion with 15,000 applications pending. [3]
533,702 Chicago residents were uninsured prior to the implementation of CountyCare. [4] With 16.4% of Cook County uninsured and the majority having poverty level household incomes, CountyCare provides those residents with primary, preventive, and chronic care doctors at facilities in their areas. [5] Many of the early enrollees to the program were extremely ill patients with multiple, unattended chronic diseases. [6] The program allows for these patients to visit a physician, seek the treatment that they need, and stabilize their health with low costs.
Cook County officials are hopeful that CountyCare will benefit Cook County hospitals and facilities. The CCHHS system already provided over $600 million in charity care for uninsured patients. [7] With CountyCare catering to those uninsured patients, County officials believe that the program gives CCHHS an opportunity to stabilize and offset previous charity costs. [8] In the 2013 fiscal year, CountyCare brought in $132 million in revenue; it is projected to generate $468.2 million in 2014, almost half of the estimated yearly revenue from the health system. [9]
Despite the fact that CountyCare allows for greater access to services at much lower costs, individuals suffering from mental illness are taking issue with the lag time between switching doctors. Individuals who switch to CountyCare and whose present mental health practitioner is not covered under the plan must find another within the plan’s limits. [10] Therapists and other practitioners are available to CountyCare users, but the transition remains bumpy. [11] Some have reported a six-month waiting period where individuals are not able to see a therapist or meet directly with a mental health practitioner. [12]
Furthermore, a number of facilities and doctors are worried about the massive influx of new healthcare users and Medicaid users switching to CountyCare. [13] Facilities, specifically in the South and West Sides where the majority of CountyCare users live, cannot handle such large numbers. [14] Not only are patients waiting months to be treated at mental health facilities, but patients and professionals alike are concerned with general access to care. [15] “Expanding coverage [does not] necessarily mean expanded access” and these facilities with huge numbers of new patients cannot easily accommodate. [16] Additionally, Naomi Lopez-Bauman of the Illinois Policy Institute is concerned with the historic difficulties that Medicaid has presented. [17] Long waits and difficulty in accessing care was present at Cook County hospitals long before CountyCare. [18] Now, with nearly 90,000 enrollees, Cook County hospitals and facilities must work to accommodate the thousands of new patients that will likely seek treatment. Unfortunately, it seems that those seeking care will have a long wait ahead of them.
CountyCare is still in its early stages. It remains to be seen if CCHHS can handle the large influx of patients and if it can provide care in an efficient manner. Nonetheless, CountyCare is fulfilling its goal of bringing healthcare to the underprivileged of Cook County and continues to gain new enrollees each day.
References:
[1] Brandeis Friedman, CountyCare, WTTW Chicago, (Jan. 29, 2014),http://chicagotonight.wttw.com/2014/01/29/countycare/.
[2] CountyCare: Frequently Asked Questions, Cook County Health & Hospitals System,http://countycare.com/about/frequentlyaskedquestions.aspx (last visited Aug. 27, 2014).
[3] Andrew L. Wang, County Health System to Award $1.8 Billion Contract to Run CountyCare, Chicago Business (Mar. 27, 2014), http://www.chicagobusiness.com/article/20140327/NEWS03/140329804/county-health-system-to-award-1-8-billion-contract-to-run-countycare#.
[4] Stephani Becker, Landscape of Illinois’ Uninsured and Underinsured: What do we know and what do we want to know before 2014?, Illinois Health Matters(Oct. 23, 2012), http://illinoishealthmatters.org/wp-content/uploads/2012/10/Slides-for-EnrollAmerica.October23.FINAL_-21.pdf.
[5] Id.
[6] Communications Staff, Cook County Health and Hospitals System Announces 1115 Medicaid Waiver, Cook County Gov(Oct. 31, 2012), http://blog.cookcountygov.com/2012/10/31/cook-county-health-and-hospitals-system-announces-1115-medicaid-waiver/.
[7] Andrew L. Wang, County Health System to Award $1.8 Billion Contract to Run CountyCare, Chicago Business (Mar. 27, 2014), http://www.chicagobusiness.com/article/20140327/NEWS03/140329804/county-health-system-to-award-1-8-billion-contract-to-run-countycare#.
[8] Id.
[9] Id.
[10] Jani Actman, Mentally Ill Face Stresses as System Changes, Medill Reports Chicago (Mar. 13, 2014), http://news.medill.northwestern.edu/chicago/news.aspx?id=229091.
[11] Id.
[12] Id.
[13] Brandeis Friedman, CountyCare, WTTW Chicago, (Jan. 29, 2014), http://chicagotonight.wttw.com/2014/01/29/countycare/.
[14] Id.
[15] Id.
[16] Id.
[17] Id.
[18] Id.