Page 14 - Bulletin Spring 2024

Bridging the Gap
County Health Insurance
Neil Manimala, MD nmanimal@gmail.com
It’s been almost a decade since the day I met a 40-something uninsured patient in the Tampa General ER. I was a young urology trainee with a full head of hair, and she was an im- migrant mother who had come in for abdominal discomfort.
We were shocked to discover her scans showed an incidental kidney mass. It looked like cancer.
As I sat across from her delivering the news, a hundred thoughts raced through my mind. How was she going to fol- low up for the next steps in management? Were we going to be able to coordinate her treatment, which almost certain- ly will involve surgery? How were we going to get medical clearance for that surgery if she didn’t have a primary care physician (PCP)? What would be the emotional and finan- cial impact on not only her but also her husband and kids?
I saw a little bit of my own family in her face – glimpses of my own mom or auntie, in her composure amidst this seem- ingly devastating torrent of bad news.
Fortunately, this patient was able to eventually acquire care through the Specialty Center at the Tampa General Health Park, and she was only able to do so by enrolling in the Hillsborough County Health Care Plan (HCHCP) for in- surance coverage.
Those early years of my training were my first experi- ences with seeing what the HCHCP does for patients in our county. As I started practice, I continued to see HCHCP pa- tients in various settings.
It became clear to me that the HCHCP is a critical safe- ty net, ensuring that Hillsborough County residents who would otherwise be uninsured have a means of obtaining medical care. To qualify, patients must have an income at or below 175 percent of the federal poverty line and cannot be eligible for other insurance plans such as Medicaid or Medi- care. Once enrolled, they can select their PCPs within spe- cific clinic networks, who can then refer them to specialists, from pain management to urology. Patients also have access to pharmaceuticals and mental healthcare.
The social determinants of health – those non-medical
factors that play an immense role in patients’ well-being, including cycles of economic disadvantage – are inextrica- bly relevant to any discussion of clinical outcomes within a large and diverse county such as ours. To understand these outcomes better and put efforts into addressing them in con- text, we must acknowledge the trajectory of the HCHCP and similar county resources from their inception to today.
In the 1990s, Hillsborough County faced compounding costs in providing care to uninsured patients. In response, the Hillsborough County Health Care Advisory Board pro- posed the HCHCP to the county commission. Local leaders subsequently asked the Florida Legislature to establish the groundwork for the present-day plan by levying a local half- cent sales tax to pay for it. The legislature agreed, and the HCHCP has been funded accordingly since 1991. (Harvard Ash Center: Hillsborough County Health Care Plan, n.d.; Tampa Bay Times Archive: Now is Right Time for Public Health-care Program, n.d.)
Over the years, the county commission has expanded the HCHCP, establishing the current income cutoff criteria in 2022. The number of eligible patients thereby increased to include many who were earning too high an income to qual- ify for Medicaid.
I’ve been inspired by this amazing work done within our county. Since July 2023, I have had the opportunity to serve as the HCMA representative on the Hillsborough County Health Care Advisory Board, which provides guidance to the county commission on the planning, funding, operation, and monitoring of the HCHCP and other county health re- sources. I’ve been grateful for the support of all members of the board, including chairperson Dr. John Curran.
Medicaid unwinding is an issue that our group has been working to address in the last year. The goal of the HCHCP is to fill the gaps in healthcare coverage for our community. The fruits of this vision have become increasingly obvious amidst the state government’s rejection of the Affordable Care Act’s expansion of Medicaid eligibility.
As a federal funding requirement, Florida had been able to temporarily expand Medicaid coverage during the CO- VID-19 Public Health Emergency, but this provision ended in March 2023. What this termination has meant is that from
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HCMA BULLETIN, Vol 71, No. 4 – Spring 2024