Elkhart County health officials preparing for Obamacare implementation

The roll-out of the Affordable Care Act looms, and Elkhart County health officials are preparing for its implementation.
Posted on Sept. 7, 2013 at 1:00 a.m. | Updated on Sept. 7, 2013 at 4:14 p.m.

Clare Krabill isn’t looking to make a statement.

She isn’t interested in wading into the stormy debate enshrouding Obamacare, the overhaul of the U.S. healthcare system that’s become a political flashpoint.

“I totally stay apolitical on it,” says Krabill, executive director of the Center for Healing and Hope, a health clinic that serves the needy and uninsured out of offices in Elkhart and Goshen.

To her — and others who work in Elkhart County’s health care sector — the more central issue is delivering health care to those who don’t have it, to the uninsured. If Obamacare — more formally, the Affordable Care Act, or ACA — can help, then so be it. That’s a good thing, a step in the right direction in improving health care.

“I think we need to try something,” says Krabill.

Indeed, as political debate simmers in Washington, D.C., between Democratic backers of Obamacare and GOP detractors who view it as unworkable and unwieldy, those in the health care sector in Elkhart County are quietly preparing for its implementation. Don’t necessarily consider them vocal, partisan advocates, though they favor the notion of extending health coverage to those who don’t have it, a central element of the ACA.

But in their view the time to debate is over.

The Jan. 1 deadline for implementation of the individual mandate — the requirement that everyone, with certain exceptions, have health insurance or risk fines — is approaching. They want to be ready.

They want to make sure the maximum number of people eligible for insurance coverage under Obamacare get it, and they’re putting together outreach plans to get the public up to speed, training staff. Among Elkhart County residents under 65, nearly 33,000, or about 20 percent of the total, lack health insurance, according to EnrollAmerica.org, a group promoting health care coverage through the ACA.

Yes, the ACA has its foes, may not be perfect, “but the reality is this is the health care we have,” said Diane Maas, vice president of managed care for the Beacon Health System, parent company of Elkhart General Hospital and Memorial Hospital in South Bend. “The time to debate is gone. I guess I would like to see us move forward with implementation.”

EGH, Indiana University Health Goshen Hospital, Memorial Hospital and St. Joseph Regional Medical Center in Mishawaka are training employees to help the uninsured sign up for coverage on planned health insurance exchanges, per Obamacare. Registration for coverage ahead of the Jan. 1 deadline, presuming no interim hiccup, is set to start on Oct. 1, about three weeks away.

Other Elkhart County clinics that serve the poor and uninsured — the Center for Healing and Hope, Maple City Health Care Center in Goshen and Heart City Health Center in Elkhart — are also gearing up to spread the word.

Tara Morris, head of the Minority Health Coalition of Elkhart County, shies from sounding off on the fierce political discourse surrounding Obamacare. But, reading between the lines, she indicates that the focus in the debate needs to be redirected.

“Without giving an opinion (on the political debate), think about the people first,” she said. “Make the people the agenda.”


If it’s lost on you that the time is nearly here for those without coverage to sign up for health insurance under the ACA, you’re not alone.

Larry Allen, chief medical officer for IU Health Goshen and a family physician, said he asks patients who he thinks might be eligible for coverage via the Obamacare health insurance exchanges if they’re aware of the option. “And all of them, 100 percent, have not been aware,” he said.

Health officials here say the looming registration period has received secondary attention amid the heated debate over the merits of Obamacare between political partisans in Washington, D.C. A movement is afoot among some GOP Obamacare foes in the House and Senate to strip the initiative of funding during expected debate later this month over a continuing federal spending resolution. The aim is to strip the varied ACA provisions of funding and halt the initiative.

The GOP effort faces a sketchy future given Democratic control of the Senate and Obama’s certain opposition. But still, the heated political discourse seems to be the focus of any Obamacare discussion, creating an atmosphere of uncertainty for the health care overhaul.

“I just think that there’s so much rhetoric that people don’t know much about it,” Maas said.

As a result, people like Patricia Gremaux, who heads community outreach efforts for EGH, are getting ready for Oct. 1. Gremaux said two people will be trained in her office to assist the public in signing up for coverage via the Obamacare health exchanges. Maas said EGH and Memorial Hospital in South Bend between them will have 30 employees capable of assisting in all, systemwide.

Informing the public about the health insurance exchanges will be one prong of efforts, according to Gremaux. Providing one-on-one guidance in the application process, perhaps through workshops, will likely be another.

A federal website has been created to help those without insurance sign up for care via the exchanges, www.healthcare.gov. The website will guide applicants through the application process, making sure they meet eligibility guidelines. It will also assist them in figuring out if they can tap federal subsidies or credits to help them cover the cost of insurance.

Picking a health insurance plan among a range of options can be daunting for someone who’s never done it, though — What’s the right deductible, the right co-pay? — and the EGH reps will aid in that process, too.

“There’s a lot of work ahead to educate the public,” said Indiana Hospital Association Vice President Brian Tabor, who offers measured support for Obamacare, glad about the new pool of people who will be able to access health insurance.


Though EnrollAmerica.org puts the number of uninsured people under 65 in Elkhart County at 32,833, 19.7 percent of the population, not all will necessarily be able to access coverage through the insurance exchanges.

The lowest-earning segment, as envisioned under Obamacare, would access care through an accompanying expansion of the federal Medicaid system. But with details of any Medicaid expansion in Indiana still to be sorted out, it’s not clear how many more, if any, will be able to get care via the federal program and some may vie for coverage via the insurance exchanges.

Accordingly, Gremaux — who’s fielded questions from the public, not totally clear on what’s going on — isn’t sure what to expect come Oct. 1, when the enrollment period formally begins. The available insurance plans and their cost, notably, have yet to be unveiled.

“Are we going to open the doors and there’s going to be a flood (of people)? I don’t know,” she said.

More broadly, the continuing political discourse in Washington, D.C., raises additional question marks. Tabor indicated that many in health care are viewing the approach of Oct. 1 with a measure of trepidation, unsure exactly what to expect.

“There’s a lot of focus on October, a lot of questions if everything’s going to be ready on Oct. 1,” he said.

Follow reporter Tim Vandenack on Twitter at @timvandenack.

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