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ACA Uncertainty: Bexar County's CareLink Pays Close Attention

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Wendy Rigby
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Texas Public Radio
Terry Abel, 58, is a new member of CareLink, Bexar County's taxpayer-subsidized healthcare assistance program.

If Obamacare is repealed and replaced with some other healthcare plan, it could have a big impact on local programs designed to help the uninsured.

In Bexar County, the people who run University Health System’s CareLink program are keeping a close eye on the debate in Washington.

Terry Abel is a 58-year-old San Antonian who works as an independent contractor translating Spanish and English. Since 2006, though, she hasn’t been able to afford health insurance.

  

Then, someone told her about CareLink, Bexar County’s taxpayer-subsidized health assistance program. She qualified.

 

"I pay $91 a month," Abel said.

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Credit Wendy Rigby / Texas Public Radio
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Texas Public Radio
Terry Able is a new CareLink member. She's put off much of her healthcare exams for a decade because she did not have health insurance.

  

Now, Abel is getting regular medical screenings she hasn’t been able to afford for a decade.

"I’ve checked my cholesterol. I’ve done a colonoscopy, a pap smear. Just the general medical stuff," she explained, as well as a breast biopsy.

Abel is one of about 26,000 people using University Health System physicians and facilities through CareLink for a fee based on family size and income.

CareLink Executive Director Virginia Mika says the 19-year-old program has made a huge impact on the health of the community.

"If we look at the average income of a CareLink member, they’re at about 91, 92 percent of the federal poverty level," Mika said. "They’re making a little less than $11,000 per year, sometimes working part time or in a job that doesn’t provide them any healthcare benefits. And they’re sick. These are people who need care."

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Credit Wendy Rigby / Texas Public Radio
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Texas Public Radio
Virginia Mika is Executive Director of CareLink.

  

Even with Obamacare, CareLink continues to play an important role for people in need in Bexar County. Texas opted not to expand Medicaid, which would have provided more subsidies for coverage through the federal Marketplace. CareLink is a safety net, providing health service for people who don't qualify for or cannot afford other coverage, people caught in the gap.

With the advent of the Affordable Care Act, CareLink membership of 40,000 declined 40 percent, a significant decrease. CareLink took an active role in assisting many of its clients to sign up for Obamacare.

"Many times these people didn’t understand what a co-pay was because they hadn’t been insured, but they were very excited to be able to have insurance," Mika added.

As a county-funded health program, CareLink is a payer of last resort, helping people if they have nowhere else to turn, assigning them a primary care physician and giving them access to specialty care.

If the ACA is repealed and many Bexar County residents had to come back on the CareLink rolls, it would impact the budget.

All of the unknowns are unsettling for people who are just trying to take care of their health, according to Mika. "

It’s the consumer ultimately who is the one faces the biggest fear and anxiety over it because people are getting healthcare. And to all of a sudden to not be able to access it is very stressful," she observed.

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Credit Wendy Rigby / Texas Public Radio
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Texas Public Radio
Bone density scans are one of the preventive tests provided to CareLink members.

Mika pledges that whatever Congress decides to do with Obamacare, she and her employees are committed to helping people enroll in any replacement program.

It’s a high-stakes issue. In 2015, University Hospital provided more than $200 million worth of care to uninsured patients.