New York Times starts series that will study Affordable Care Act's implementation and impact in Louisville area

It's the calm before the health-care storm, and amid the uncertainty of how the health-care reform law will be implemented, health-care conditions in Louisville, Ky., seem to make it a good environment for a New York Times series that will study the process and its impact.

Reporter Abby Goodnough writes that Louisville, a city with four hospitals, a medical school and one of the nation's largest health insurers, "embodies both the triumphs and the shortcomings of the medical system in the United States." She notes that despite such resources, Kentucky continues to have dismal health outcomes, including some of the nation’s highest rates of smoking, prescription-drug abuse, and deaths due to cancer, diabetes and heart disease.

To watch the six-minute New York Times video, click here.
The health law is intended to address some of those shortcomings, and the potential health benefits to the state are huge. About 90,000 people could get Medicaid coverage in Louisville alone, and the law could also "create thousands of jobs in Kentucky and, if its aspirations are realized, provide better care at lower cost," notes Goodnough.

However, there are many concerns about the law's implementation among health-care providers and Americans in general, both insured and uninsured. Republican Sen. Mitch McConnell says the 2,700-page bill and more than 20,000 pages of regulation is "a massive bureaucracy" not understood by doctors, hospitals, states, small business and most Americans. Regardless, in January the law will require most Americans to have health insurance, or they or their employers will pay a penalty.

Providers and patients: Challenges to providing and receiving care on the front line

For providers, "This is a period of fevered preparation for the far-reaching changes," and many clinics, practices, and health systems are hiring coaches and consultants to meet the demands of the federal health care overhaul, writes Goodnough.

She focuses on the challenges ahead of one such coach, Danny DuBosque. He was hired by Family Health Centers, one of the many clinics and practices across the state that must prepare to treat thousands more newly insured individuals as a result of the law, while simultaneously converting paper charts to electronic medical records to avoid federal penalties. Many practices, particularly in Kentucky's rural areas, are already struggling to stay open, due partly to resources required for this conversion process and problems associated with Medicaid payments from managed care  companies.

Clinics like Family Health Centers, which provide services to patients regardless of their ability to pay, are at a front line of the health law's changes, writes Goodnough. They represent many obstacles now faced by primary-care providers in Kentucky: They serve Kentuckians who are often unhealthy and tend to put off preventive care; they earn less than most physicians; and they are worried about having the staff and money to treat newly insured patients.

Front-line providers like Alaina Brohm, a nurse practitioner in Louisville's West End, treat "a diverse and challenging population: the unemployed, the chronically depressed, the obese, patients with advanced diabetes and feeble hearts," reports Goodnough. She describes the heartfelt stories about patients trapped in the health care system and investigates anticipation of medical coverage from the patients' perspective. (Click here for more details.)

Brohm's patients are often unable to pay for necessary treatments and medications, and they have a hard time even finding transportation to the clinic. One such diabetic patient, identified only as Ms. Edwards, cannot afford medicine to control her blood sugar, and she is depressed by that and her lack of insurance, writes Goodnough. But she will qualify for Medicaid under expansion next year.

Yet, patients like Ms. Edwards and Mr. Elson, who is unable make health insurance premium payments because his diabetic condition led to a 400 percent cost increase, are still skeptical or fearful of the health care law, writes Goodnough. "I don't see it helping anybody, just making everybody get insurance," he told her. Family Health Centers' providers are worried too. Brohm told Goodnough she is concerned that poor, newly-eligible Kentuckians will be required to pay part of their medical costs and she knows of a business that may be sold because it cannot afford employee insurance. (Many businesses don't know about subsidies available for that.)

On the other hand, Gov. Steve Beshear's decision to expand Medicaid with the law is a historic, long-awaited one for Bill Wagner, director of Family Health Centers, reports Goodnough. It will allow about 308,000 Kentuckians to gain insurance coverage, which is almost half of the state's uninsured population, and it may solve the $3 million budget shortfall faced by the center, she writes. As a Federally Qualified Health Center, it has already received $5.4 million to expand its facilities.

Placing waterproof boots on the ground while Louisville prepares for the storm, Goodnough sets the stage for an interesting and highly complex view of the health law's impact that, rather than focusing on the political debate surrounding the health care law, tells tales of patients and providers in the eye of the storm of change. Stay tuned for more alerts.

Health care providers, employers and patients can click here to contribute to Goodnough's reporting by telling about expectations for the health law and their previous experiences with health care in the Louisville area.
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