WHAT DOES FEDERAL HEALTH REFORM MEAN FOR ALLIANCE? By Dana E. Simpson, Esq. Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P and Alliance Medical Ministry Board Member

What does federal health reform mean for Alliance Medical Ministry? Will reform help all of Alliance’s patients obtain health insurance coverage? These are common questions asked by many Alliance supporters. As we move closer to the implementation of the Affordable Care Act (“ACA”) in 2014, it is becoming clear that (unfortunately) the ACA will not solve the problem of the working uninsured in our community and there will continue to be a great need for Alliance’s services. The ACA should help provide insurance coverage for some Alliance patients, but working uninsured individuals with incomes at or below the federal poverty level will continue to lack access to affordable insurance coverage. Here’s how it will work. Approximately 98% of Alliance’s patients have incomes less than 200% of the federal poverty level. The ACA will help subsidize the purchase of private health insurance through a federal exchange for Alliance patients with incomes between 100% and 200% of the federal poverty level. Ironically, however, the ACA will not provide insurance coverage for those Alliance patients with the fewest financial means - namely those at or below 100% of the federal poverty level. This is because the ACA was initially designed to expand Medicaid coverage for lower income adults, but the State of North Carolina has chosen not to expand Medicaid at this time.

The lack of Medicaid expansion in North Carolina means that a large number of working adults in our community will remain uninsured. Recent estimates by the NC Institute of Medicine found that approximately 123,000 adult residents of Wake County lack access to affordable acute and primary medical care. If 50% of these residents receive subsidies to purchase health insurance (which is consistent with initial Congressional Budget Office estimates), then this will still leave 75,000 Wake County residents without insurance. Last year, Alliance provided a primary care home for 8,000 active patients. This representsjust 10.5 percent of all Wake County residents who will lack access to affordable insurance coverage following implementation of the ACA in 2014. These numbers make it clear that the need for Alliance’s primary care services in our community will continue.

Although Alliance’s services will still be very much in demand, implementation of the ACA will necessitate change for some current Alliance patients. The Alliance staff and Board of Directors are working on developing a plan to help our patients who become eligible for federally subsidized private health insurance in transitioning to new health care providers that accept such insurance. This will allow Alliance to create additional capacity for the thousands of other low-income working uninsured adults that have not previously been able to become patients at Alliance due to capacity limitations.

The staff and Board are committed to ensuring that Alliance continues to provide a medical home and compassionate care for the working uninsured in our community. We need the continued financial support of our donors to allow Alliance to sustain its critical mission during this time of health care transition. While we all pray that one day everyone in our community will have access to affordable health insurance, until that time comes the staff, volunteers, and supporters of Alliance will continue to live out our calling to “Love Thy Neighbor.”