Some of our donor partners have asked what the impact of the Affordable Care Act will be on Family Health Care's work and our need for on-going charitable support. These are the frequently asked questions and answers.

"The Affordable Care Act is saving lives and should not be scrapped. Improvements could be made if the US Congress ever chooses to move from square one. The majority party in the House has voted for repeal more than 60 times without success. If they were doing their job, they would find elements for improvement and stop the redundant votes that go nowhere and help no one." S Lee MD

For the first time, the US has acknowleged the need for health insurance coverage for all Americans; not just those over 65 (Medicare since 1965) or under 19 (Children's Health Insurance Program since 1997). Researchers from Harvard Medical School found that a lack of health insurance caused about 45,000 deaths a year in the United States during the past few years. The Affordable Care Act will greatly reduce the number of these deaths.
Whether you call it the Affordable Care Act or Obamacare, the changes are underway. Passed by Congress, approved by the Supreme Court and re-affirmed with President Obama's re-election; elements of the ACA are coming on-line and are beginning to have a real and mostly very positive impact.
At Family Health Care we are celebrating because it is our hope that we will not have to sit helplessly as patients die due to lack of insurance. For example, Mr. Long (not his real name) who has somehow managed to survive with severe renal failure this year. His creatinine level which measures kidney function and normally should be 1.35 or below is now 9.23. Yet, we have been unable to have him seen by a kidney specialist to start dialysis because he has no insurance and no money to pay the more than $100 first visit fee. 

Health reform bill is withdrawn- Channel 4

Look at all these changes: 

New benefits and protections for people with insurance under the ACA, this act:

·        Requires insurance plans to cover wellness checks and preventative services and immunizations without co-pays or fees.

·         Protects people with pre-existing conditions- no discrimination due to health status. 

·         Ends all lifetime limits on insurance coverage and ends annual coverage limits for essential benefits.

·         Allows for family coverage for students until age 26.

·         Ensures coverage for individuals regardless of pre-existing health conditions.

·         Caps out-of pocket expenses.

·         Changes employer-based Insurance (subsidized by tax credits for small businesses):

o   Required coverage for all full-time employees by 2015 (for businesses with more than 50 employees).

o   Cannot inflate costs due to sick employees (with pre-existing conditions)

·         Creates exchanges for insurance marketplace- competing on a level playing field with requirements to make the insurance plans understandable.


Plus- Insurance companies may not spend more than 20% of your premiums on their administration costs (insurance company executives cannot take out the outrageous salaries.)

H. Edward Hanway, the CEO of Cigna made $14.6 million in 2009. Ronald Williams, Aetna's CEO made over $18 million in 2009. Angela Braly, the CEO of Wellpoint, made $13.1 million in 2009. According to Neil Wagner at the website "The doctor will see you now" and based on 2009 national averages, Mr. Hanway's salary could have paid for:

  • Health insurance for 3,000 individuals ($4,824 each) or 1,100 families ($13,375 each)
  • 241 full-time nurses ($60,000 per year each)
  • 209,000 additional prescriptions filled ($70 each) 

Most people in most states will see a reduction in health insurance plan costs.

Doesn’t the affordable care act cover everyone now?

 No. There are many who still fall through the cracks. Our philosophy of charity care is to provide for those who don't have other options. Family Health Care's focus is the uninsured poor.  

 Was the ACA poorly designed?

The Supreme Court disconnected the portion of the Affordable Care Act (ACA) covering very poor adults from the rest of the plan. Part of the plan was that the ACA would cover these individuals through expanded Medicaid. After the decision by the court, the majority of states chose to expand medicaid to cover people with incomes under 100% of poverty. The states of Kansas and Missouri chose not to expand Medicaid services to cover very poor adults. There are many possible reasons for this decision. Perhaps the policymakers really believed private charities could make up the difference. However, the result five years later is that about 160,000 Kansans and about 240,000 Missourians who have very low incomes do not qualify for coverage through the ACA. Those with incomes over 100% of poverty qualify for ACA subsidies and assistance paying for private insurance, but those with incomes under the poverty level have no assistance (remember they were meant to be covered by expanded Medicaid.) That leaves only charitable care for these vulnerable people. Family Health Care provides charitable care with the help of donors and foundations here in Kansas City. We are beholden to those that have the ability and are willing to help as we have maintained our commitment to the uninsured poor.


Will Family Health Care have any operational changes based on the ACA?

Family Health Care operates as a non-profit charitable medical practice both in name and in activity. We choose to serve a very vulnerable patient population. Many of our low-income patients have social situations or secondary diagnoses (such as mental illness) that impact their health care and their ability to navigate through services. We provide added value services such as: social services, literacy, peer education, legal, and other supports meant to help patients optimize their health (these services are not covered through health insurance).


Will there be changes in the revenue streams for Family Health Care?

The most important income source is from donations and grants- this accounts for half of our income and will continue to be important as our revenue from fees for services is projected to worsen. Our current revenue streams include fees-for-services from public and private insurance, as well as self-pay fees on a sliding scale. We have actually seen an increase in the proportion of self-pay patients (with a resulting decrease in payments). Our choice is to provide for the uninsured and refer those who gain insurance. We refer many insured patients (including those insured by Medicaid) to other practices in order to open our schedule and provide more services for a growing proportion of uninsured patients. Other clinics are focusing on the Medicaid or newly insured population rather than opening their schedules for the uninsured poor. 

"The refusal of the Kansas and Missouri governments to implement Medicaid expansion is short-sighted and mostly ignorant (ie-

lacking knowledge). Worse, although it has been clear for years how the decision would affect low-income people in both our states, the legislators and governors have refused to even prepare for the changing situation they have set in motion. The safety net of clinics and the emergency rooms (especially those hospitals that were subsidized through the Disproportionate Share Hospital payments to provide care for the uninsured) are certain to be stretched thinner and people in our States will suffer due to this colossal governmental feat of willful inaction."  - Sharon Lee, MD 

Real stories about people who are falling between the gaps in our health care system. (Click here)


 Family Health Care will continue to have to fund (through donations and grants) the difference between the costs of services and the income derived from insurance and self-pay fees as long as we continue to serve a high proportion of people whose payments do not make up the full costs of services. We continue to keep costs as low as possible and provide services through volunteers and semi-volunteer professionals (all paid at the same modest hourly wage). Charitable funding is also applied to our ancillary (not covered by third party) services such as social services supports, peer educators, etc. These supports are not required in many practices, but are important for our vulnerable patients.We thank all those who are a part of our work to make a better world through donations and other support.

What we need- Universal Coverage

Not "socialized medicine"- that's the VA.

Just paid by the public- like Medicare.

Expand this coverage, allow buy-in by individuals or employers and that is Universal Health Care.



Click on these sites for more information...


Center for Medicare and Medicaid Services.Gov

How the ACA will affect KC Safety Net Clinics.

Affordable Care Act


Learn more about Medicare For All...

The Whitehouse Website

Cartoon explanation of why we need a national health plan.

Napkin explanation of why we need a national health program.