Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal

Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.

She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.

“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.

The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.

All thanks to money from the Affordable Care Act.

“I guess it's true, build it and they will come,” Morris says.

President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from rural, Republican counties in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.

With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.

“That was a real boon to us,” says Dave Jones, CEO of Mountain Valleys clinics. “We went from struggling payday to payday, to actually having a reserve at this point.”

In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.

Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by Partnership Health Plan, the insurer that manages Medi-Cal in far northern California.

One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.

They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.

“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”

The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.

And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.

“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”

Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.

“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.

“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”

Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.

“Most of them come through everyday, before or after work,” she says.

The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.

“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.

That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.

He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to formally oppose the Republican health bill, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.

Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.

“If we have to revert back to where we were,” Jones says, “it could be disastrous.”