Featured Stories

Other Pamplin Media Group sites

A complicated road to coverage

OUTLOOK PHOTO: JOSH KULLA - Gary Williams and Dina DiNucci share a laugh during a recent consultation at the Rockwood Station apartments, where DiNucci visits weekly to help enroll residents in availalbe health care plans. Three years ago, when the Affordable Care Act — known to most as Obamacare — first rolled out, the technical problems of getting insured overshadowed the benefits to actually getting insurance.

To help people navigate the system, the federal government flooded health care clinics with “assistors,” employees whose sole jobs were to go through paperwork with patients and get them into the system. Some clinics received federal dollars, too, called a Health Resources and Services Administration grant, to hire on additional staff.

In Rockwood, Wallace Medical Concern (WMC), a volunteer-run, federally qualified health center headquartered in the Human Solutions Rockwood building, 124 N.E. 181st Ave., got both.

It would stand to reason that several years later much of the need for assistors should have dissipated. On all accounts, Healthcare.gov is a smoother experience and those who were first-time users of the system in 2013 now simply have to re-enroll.

And for most parts of Oregon that narrative is true, except in Rockwood.

“(Wallace Medical Concern) serves a bunch of different communities that don’t trust the government or the state and it is a lot different than other areas of Oregon or Portland,” said Adelle Pomeroy, lead eligibility and benefits coordinator for Wallace Medical. “You’ll go to (health insurance) collaborative meetings where they’re airing their issues, most will be technical ... but out here it’s more like, how do we verify identity when the federal system verifies identities based on credit score, and if you’re a refugee you don’t have a credit score … it becomes a lot more of a puzzle than just what program can this person qualify for.”

In a cramped office, Pomeroy, who is one of the employees hired two years ago through the federal grant for health insurance enrollment, and others spend hours on the phone fighting for the rights of residents who happen to be refugees, or people experiencing homelessness, non-English speakers, veterans and others.

Open enrollment for health insurance began on Nov. 1 and ends around Dec. 31, though health care workers stressed that the final date is often pushed back.

To illustrate the need for health care and insurance in Rockwood, look to the 2013 (the most recent) Truven Community Needs Index, which ranks zip codes on a scale of 1 to 5, with 5 being the highest need based on a number of factors. The ZIP code from Southeast 122nd Avenue to Southeast 202nd Avenue — 97233 — ranked in the Top 15 neediest ZIP codes in the state. And more specifically, 97233 was the only ZIP code in Oregon to have an overall score of 5.

Characteristics of those needy zip codes paint a picture accurate of West Gresham. Many residents who live there haven’t graduated from high school; many live under the poverty line; many families speak little to no English; many residents are uninsured; and the majority of families rent their homes.

In the practical sense, those characteristics serve as barriers to getting equal treatment under the federal health insurance system.

A laundry list of problems

It’s a time consuming job getting people hooked into the health insurance system — staff at Wallace Medical Concern budget two hours per meeting for one enrollment — that can include many twists, turns and bumps along the way.

For example, a patient who is homeless — and 1 of 5 patients who use WMC is homeless — has no address. To apply for health insurance, the application doesn’t require an address but it does require folks to put a ZIP code where they spend most of their time.

However, when the application is submitted, it can look like there is missing information and it risks being denied.

Then, Pomeroy or someone else has to contact the homeless person to come back to the clinic, and this is where it gets tricky. The person may have moved to a new location, or found housing, or the phone number they used at the time may no longer be in service.

Dina DiNucci, manager of public relations at Wallace Medical, said many of the homeless people in Gresham use the Anawim Christian Community Church as their address, but even so many insurance cards never reach their owner.

If the patient is a refugee, the rules are even more complicated. Pomeroy explained that refugees have the right to free health insurance when they come to the United States; however, it’s canceled if they don’t supply a Social Security card within three months. Often times, refugees don’t know about this rule and their insurance is canceled without their knowledge.

Many refuges are also new to paying taxes, but must include tax information on their health insurance form. Mothers may not know whether they file their taxes jointly with their husband, or other information. Pomeroy said she does everything she can to get that information while the person is in the clinic, because otherwise the application may not get filed at all.

“You can’t let them leave,” Pomeroy said. “The minute you let them leave, there is a 10 percent chance you will ever see them again. Their phone isn’t working or their address isn’t correct. If we let them leave we would just have a stack of applications with missing information.”

“To be an enrollment assistor you have to be an insurance agent, tax agent, and an immigration lawyer,” said Maria Perez, a program manager with WMC.

Another issue with the refugee community is many worry that signing up for insurance will affect their immigration status, and staff at Wallace Medical often spend a long time assuaging fear in those who have come from places where the government is not to be trusted.

With the Hispanic population, problems arise with just getting their names correct in the system.

“Nobody has a structure of how to enter a Latino person’s name, nobody has a standard,” Pomeroy said. “We’re talking about how there’s all these complications, and one of the biggest issues is just your name. What is the most simple thing when you meet someone? Your name.”

Whole names will be left off, or letters will be missing from a name. Wallace Medical gets calls weekly from families wondering why, when they have successfully applied for health insurance, are still getting denied coverage. Many times the reason is because their name doesn’t match what’s in the system.

In the first two years, Wallace Medical staff said they could be on the phone eight hours a day fighting for patients’ coverage. This year, it’s slowed to about twice a week.

For many, having insurance

means freedom

Beyond the headaches of enrollment, the paperwork and the multiple phone calls made to the Oregon Health Authority, Wallace Medical continues to go gangbusters during open enrollment because, on the other end of a frustrating process, real people are being helped.

DiNucci goes to Rockwood Station, 19100 E. Burnside St., every Tuesday to chat with people about their health care options, answer questions and provide guidance.

Gary Williams, a newer resident to Rockwood Station, said DiNucci’s support has helped him tremendously.

Before getting a housing voucher to live in Rockwood Station, Williams, a veteran of the Navy with diabetes, was homeless.

With advice from DiNucci, Williams was able to switch to a plan that made his diabetes medicine free. He also was able to avoid an hour-or-more bus trip to the Veteran’s Affairs office in Portland to get health care. Under his new plan, he can take a 15 minute bus ride to Legacy Health for treatment.

“Dina’s followed up with me to make sure things were getting done. She’s offered to answer additional questions or get additional information for me,” Williams said. “I’ve been here a little over two years and she’s gone out of her way. I think they’re doing a fantastic job.”

Williams story is not unique and it’s the reason, despite all the roadblocks Wallace Medical faces every day, the staff continue to push to get people insured.

And now that Wallace Medical has the ability to bill health insurance companies, the organization has been able to hire more staff and serve more people.

“Our revenue has increased,” Perez said. “We started as a volunteer-based clinic and now we have 40 staff because of the Affordable Care Act.”

Plus, for people whose only access to health care was the emergency room, there are now a whole new host of services they can use to stay healthy, like going to the dentist or eye doctor.

“That’s really neat to be able to explain,” Perez said, of helping patients.

“A lot of our patients deal with chronic disease management ... and are constantly using the clinic, so when they find out that they don’t have to pay as much to keep themselves healthy, that there are other things available like nutrition classes and acupuncture, they can take advantage of that,” Pomeroy said. “If they have health insurance they have a lot more choice ... and they don’t necessarily have to go to the clinic that is 17 miles away from where they live by public transit. They don’t have to pay the cab or pay their friends.”

Getting health insurance is just as important for those who aren’t sick, too, Pomeroy stressed.

“If you are a healthy person, and you’re a young person and you eat nutritiously and exercise all the time and think your stress levels are managed, you still don’t know what’s going to happen in life,” Pomeroy said. “Life is totally unpredictable and health insurance is just necessary in this day and age.”


Local Weather





Humidity: 82%

Wind: 0 mph

  • 24 Nov 2015

    Partly Cloudy 43°F 32°F

  • 25 Nov 2015

    Sunny 42°F 32°F