How Obamacare Is Changing the ER

Our Hospital Emergency Room Sees 400 Uninsured Patients Each Month. My Job Is to Get Them Covered.

Every month, nearly 400 people without health insurance visit the emergency department of the San Jose hospital where I work. Some of them come in after an accident. Others have chronic health problems but have nowhere else to go—their primary care physician is basically the emergency room.

In the past, all we could do for many of these patients was offer them a quick fix: bandage them, take away their pain, and send them on their way. Most of these patients were low-income but didn’t qualify for Medi-Cal, the federal-state program for needy Californians. They usually ended up back in the emergency department sooner or later.

As the benefits resource manager for O’Connor Hospital in San Jose, I oversee the uninsured population and provide my staff with resources for the community we serve to assist patients with their medical needs. My job has changed a lot since the Affordable Care Act (ACA) took effect on January 1, 2013.

Before ACA, we saw a lot of patients whose incomes qualified them for Medi-Cal, but who didn’t meet the other requirements.

Now, we are able to talk to every uninsured patient who visits the emergency department—either in the Health Benefits Resource Center right down the hall or at bedside. We ask them a few basic questions to determine their eligibility and provide them the information they need to get enrolled in either Covered California or Medi-Cal.

Before ACA, we saw a lot of patients whose incomes qualified them for Medi-Cal, but who didn’t meet the other requirements. Back then, Medi-Cal was limited to people between the ages of 21 and 64 who had a child or a disability. This left a lot of low-income people uninsured.

For example, if a middle-aged, low-income woman came into the emergency department in diabetic shock, all we could do was offer her a charity application to cover that visit. If she didn’t have children or a disability, she didn’t qualify for Medi-Cal. We’d refer her to a clinic to see a specialist and write a prescription—but she couldn’t afford either that visit or the insulin.

If that same woman visited the emergency department tomorrow, I’d enroll her in a new program we implemented this year called “hospital presumptive eligibility,” which is temporary coverage for two months. We would then offer her an appointment to get step-by-step assistance with the application, as well as a list of clinics where she could see a specialist.

For some patients, it comes as a surprise to learn that they have these options now. Though there’s been extensive media coverage and information about the Affordable Care Act, many people think they’ll have to pay for it. They don’t know about the subsidies for people who buy plans in the Covered California exchange—or about the expansion of Medi-Cal. They also don’t know what steps they need to take to get signed up. That’s where we come in.

In the first open enrollment period in July 2013, we certified all of our enrollment counselors and saw 75 to 100 patients in a month. At that time, the counselor worked with patients to go through the entire application, which could take up to two hours for a family of four.

Since implementing this fast track to enrolling in Medi-Cal here at O’Connor Hospital in July 2014, we’ve been able to help 300 to 400 patients get temporary coverage and a start on their Medi-Cal application until they are able to apply for their full coverage.

When we first approach people, we try not to overwhelm them with too much information. People who come into the emergency department without insurance are worried about how to pay the hospital bills. We tell them,“If you’re willing to answer a few questions and you qualify, we have a program that might help pay your bill today and get the medication you need.” We’ve received many hugs from grateful patients!

I find my job extremely fulfilling. I enjoy being able to help people and think it’s wonderful that because of the Health Benefits Resource Center and the programs we have implemented, we can do more for patients today than ever before.

Araceli Martinez has worked in the healthcare industry for over 15 years. She is currently benefits resource manager for O’Connor Hospital in San Jose, California.
This article is part of “The 19 New Californias,” a partnership of The California Wellness Foundation and Zócalo Public Square that explores how the Affordable Care Act is affecting communities around the state.
Primary Editor: Becca MacLaren. Secondary Editor: Joe Mathews.
*Photo courtesy of Taber Andrew Bain.


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