Cheryl Stumph, who owns a garage and has six children, qualifies for Oregon鈥檚 Medicaid program (Photo by Kristian Foden-Vencil/OPB).
Millions of Americans who didn鈥檛 have health insurance last year now do, as a result of the Affordable Care Act. In Lane County, Oregon, is struggling to deal with a huge influx of new patients. CEO Terry Coplin says they expected 26,000 people to sign up in the first few years. Instead, about that many signed up in the first few months.
鈥淲e weren鈥檛 expecting to get such a large assignment of patients in the first two months,鈥� says Coplin. 鈥淭hese patients who are coming onto the program, many have not seen a physician for years. We鈥檙e dealing with not just a large number of patients, but also what appears to be a much sicker population of patients.鈥�
Cheryl Stumph is one of them. She and her husband Mike run , an all-service garage.
鈥淐ars and trucks and tractors and generators and lawn mowers and boats and motor homes and I think the only thing I haven鈥檛 done, or my husband hasn鈥檛 done is an airplane, so far,鈥� she says.
In November of last year, Stumph鈥檚 27-year-old son had a stroke and died at the wheel of his tow truck. The stroke stemmed from a genetic problem so Stumph spent this winter worrying about her six other kids. Genetic testing is expensive and she didn鈥檛 have health insurance.
But now she and her family get Medicaid through Trillium Health.
鈥淭hat was really relieving,鈥� says Stumph. 鈥淵ou know, because we can check on the other kids and maybe not lose them. And oh my God, we鈥檙e 50 and aren鈥檛 there things we鈥檙e supposed to do at this age of our lives? And you know, we鈥檙e doing it, and it鈥檚 great. It just gives you hope.鈥�
She鈥檚 thrilled to be able to get a mammogram and treatment for a long-term infection she鈥檚 been dealing with. The kids can get genetic testing and her husband too, she says, has a chronic medical problem that needs attention.
Stories like Stumph鈥檚 are being repeated across Oregon, and it鈥檚 overwhelming Trillium Health.
Trillium鈥檚 Coplin says the coordinated care organization has come up with a four-part plan to deal with this unexpected influx.
First, it will pay bonuses to doctors who accept new members.
Second, Trillium is granting Lane County $900,000 to open a new clinic in an existing building. A custom build would take too long. 鈥淭hey have proposed ways that they can get this clinic up and running by mid-year,鈥� says Coplin.
Third, Trillium is hiring a consultant to see if existing clinics can increase efficiency, for example, by changing who fills out forms.
鈥淗aving physicians do clerical work is really a waste of valuable resources,鈥� he explains.
And finally, Trillium is offering half a million dollars to any clinic or group of physicians willing to expand their practice to take on another 5,000 adults.
Meanwhile, Trillium has some short-term fixes to help new enrollees find doctors in the area.
Coplin says if they have a serious accident, they can go to the emergency room. If the injury is less serious, they can go to urgent care.
But someone who is suffering with a minor complaint can fall through the cracks.
Lane County Public Health Officer Dr. Patrick Luedtke thinks Trillium鈥檚 plans will likely work, but he鈥檚 anxious about those cracks.
鈥淲e have a shrinking pool of providers and we have a growing need in an aging population for health care. So that鈥檚 pretty classic irresistible force meeting an immovable object.鈥� It鈥檚 tough to have those two circumstances in the same environment, he says, 鈥渟o we need to get creative and that鈥檚 what we鈥檙e doing.鈥�
Cheryl Stumph is pleased to be getting treatment, but it hasn鈥檛 all been easy. 鈥淚t took a month I think to get the first appointment for my husband,鈥� she says.
They鈥檝e been for several appointments and the doctor told Stumph she鈥檇 have to give up smoking, get a little more exercise and follow all the usual doctor recommendations. She says she is working on it.
This story is part of a partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.