The Affordable Care Act, popularly known as Obamacare, was signed into law in 2010 and was implemented in stages over subsequent years.

Among many features, it was slated to improve the quality and affordability of health insurance and ensure that more uninsured Americans would be covered regardless of any pre-existing conditions.

Still, it was a highly contentious issue, especially among Republicans — many of who had expressed a desire to abolish it altogether.

With the recent victory of President-elect Donald Trump and a fully Republican-backed Congress, the future of the Affordable Care Act (ACA) looks more uncertain than ever.

For some organizations in the Southeast Texas area, however, the implementation of ACA had little to do with their day-to-day operations.

“It has not affected the way we provide services,” Carl Dahlquist, Outreach & Enrollment Supervisor for Gulf Coast Health Center, said.

“Gulf Coast is a FQHC, which means Federally Qualified Health Center… We accept any kind of insurance — private insurance, Affordable Care Act insurance, Medicaid, Medicare, CHIP, Tricare.

“For people without insurance — which is our basis — we put them on a sliding fee scale. The sliding scale is dependent on household income and household size, which makes them pay anywhere from $30 to $75.

“So that’s the basis of Gulf Coast.”

Dahlquist did not express any concern regarding the ACA’s uncertain future with the President-elect and his new administration.

“Whatever happens to the Affordable Care Act, Gulf Coast will be here to provide services for this and all the communities that we’re in,” Dahlquist said. “Whatever happens to it happens to it. It won’t affect us in any way.”

Dahlquist explained some of the GCHC’s policy toward low-income patients and those without insurance — specifically the people thought to be most affected by a sudden loss of the ACA.

“If you were to go to a regular doctor, they have a set charge to see the doctor, which is usually several hundred dollars,” Dahlquist said.

“Whereas, the majority of our patient population is low income. So, in order to get low-income people to come to the doctor, that’s the reason we do what we do with the slide.”

According to Dahlquist, the GCHC receives much of their funding from the Health Resources & Services Administration (HRSA) due to its standing as a FQHC.

However, even with talks of HRSA cutting its budget from a couple of years ago, Dahlquist said that it would not hurt the GCHC much if it did lose the funding.

“It would hurt us a little bit, but we would be able to maintain just about all of our services,” Dahlquist said.

Such services, as offered by the Outreach & Enrollment Supervisor through the Community Health Department at the GCHC, are as follows:

“So, what we do is we help people sign up for Medicaid, renew their Medicaid, their CHIP, their food stamps. We do the Affordable Care Act…” Dahlquist said.

“And when I say we do the Affordable Care Act, if you were to come sit down in front of me, I would take you through A through Z.”

“That’s doing the application online,” Dahlquist said. “That’s showing you the insurance plans, telling you about the insurance plans and even enrolling you into the insurance plans.

“The only thing I don’t do is take the money — and we’re actually HRSA-granted for that.”

Dahlquist explained he and his staff were also what they called application counselors, many of which were also granted through HRSA.

And regardless of politics, many people took advantage of signing up with the ACA, according to Dahlquist.

“The first, second and third year we had a pretty good outcome, as far as people coming to sign up and people coming to renew (for ACA),” Dahlquist said. “This fourth year has been a little slow.”

The GCHC worker attributed that to recent changes in Washington.

“Personally, I’ve had people tell me they really don’t know what to do because of the presidential election and Trump saying he’s going to abolish it,” Dahlquist said.

“I’ve told them they can’t just abolish it. There’s a process, even though it’s the federal government, there’s a process.”

According to Dahlquist, the ACA was intended for those individuals who fall somewhere within the federal poverty level.

“The Affordable Care Act is for those people who are between 100 and 400 percent of the federal poverty level and file taxes. If you’re under 100 percent of the federal poverty level, you can still get it, but you won’t be able to afford it,” Dahlquist said.

“For those people who are over 100 percent, that was the government’s starting point to where if you start at 120 percent of the federal poverty level you qualify for tax credits, which are turned around and used for your premium and then you’re eligible for cost sharing, which also lowers deductibles and co-pays.”

More specifically, individuals who fall between 100 and 200 percent qualify for cost sharing and individuals who fall between 100 and 400 percent qualify for tax credits.

Dahlquist expressed admiration for certain parts of the ACA, such as the clause where insurance companies must accept anyone, even those with a pre-existing condition.

“That’s one good thing about the Affordable Care Act,” Dahlquist said. “Before it came along, the insurance company could exclude your diabetes or high blood pressure, which now they can’t — which is a good thing.”

“Do I like the Affordable Care Act?” Dahlquist asked. “Yes. I have helped a lot of people who couldn’t get insurance, get insurance.

“I’ve helped a lot of people; and I’m thinking it’s helping a lot of people.”

Dahlquist said there’s been talk about a possible overhaul of the ACA by Trump, but not a complete abolishment, which would potentially leave millions of Americans uninsured.

“The number one person who would get hurt in all of that would be the people, the ones who voted for you,” Dahlquist said.

Dahlquist went on to say that both the public and the insurance companies would be adversely affected if such a dramatic repeal of the ACA would occur.

“Insurance (companies) are getting the premium you’re paying them and then the government is paying your tax credit to them. If the government stops with the tax credit, that’s going to boost your premium up, so now you’re not going to be able to pay it and the insurance company is going to be at a loss, too.”

According to Dahlquist, the people who would be most affected by such a move are the people he and the GCHC aim to help.

“That’s why there’s places like Gulf Coast and Legacy. That’s whom we focus our co-pay base around. It’s for those people; so, they can afford to go to the doctor.”

According to Dahlquist, the GCHC serves, on average, over 3,000 people a month at its five locations. That figure only includes the general medical services, not any of its other comprehensive services like dental and mental health.

“We do health fairs; we do presentations,” Dahlquist said of GCHC’s outreach programs.

“As far as our outreach program, this time of year we go door to door to businesses.”

Dahlquist also listed GCHC as a member of different organizational committees and partners with medical centers like Christus and Baptist.

Nevertheless, when it comes to helping low-income and uninsured individuals, Dahlquist’s message seemed to be the same.

“For those patients, I tell them to come in and sit down — you may qualify or you may not qualify. But if you quality for it, good; but, if you don’t, it doesn’t cost you anything to come in and talk with a person.

“Because if you don’t come in and talk with the person, you’ll never know.”

Dahlquist expressed a similar view of the ACA.

“The way that the Affordable Care Act is set up, you can come in and sit down, and I can do an application for you… I can show you the results and what you’re eligible for.”

Dahlquist said he’s had some patients who spent $5 a month under certain ACA conditions.

“I’m not going to call you like some insurance companies would. If you’re not interested, that’s it.

“I can do the application and then show you the results. You’re under no obligations.”

In Dahlquist’s words, the ACA “took the locks off of insurance.”

For another local organization, the implementation of the Affordable Care Act had a similarly minimal impact.

“It has not affected the way we provide services,” N. Charles Harris, PhD and CEO of the Spindletop Center, said. “Some of the consumers we serve may have obtained coverage through the ACA and therefore we had a different payment source for them.”

Harris echoed Dahlquist’s belief, however, that the ACA especially helped those with pre-existing conditions.

“Those with pre-existing conditions definitely benefitted in the sense that they were able to get coverage when they may not have been able to get it in the past,” Harris said.

“In a general sense, having coverage may have encouraged people to get treatment before their condition worsened requiring more extensive and expensive treatment. That is a plus for everyone.”

Regardless of what the President-elect may or may not do with the ACA when he comes to power next year, Harris did not express any undue concern about Spindletop’s ability to cope with it.

“Since we serve consumers regardless of their ability to pay or insurance status, those individuals who meet the criteria for eligibility for our services will continue to be served regardless of changes in the ACA,” Harris said.

“However, since there is a high demand and need for our services, changes that impact the revenue we collect through third party payers, especially Medicaid, could reduce our ability to serve the number of people we do now or could reduce the level or amounts of service we provide.”

In regards to the possibility of the ACA being rejected entirely, Harris expressed some skepticism.

“While the new administration and congress have been fairly clear in their intention to ‘repeal and replace’ the ACA, this is easier said than done…” Harris said.

“What is more likely is that the ACA will be changed through the process of budget reconciliation… However, this can only be used to change those parts of the law related to funding.”

Harris also said that while such a move could result in millions of Americans suddenly losing health insurance, he doubted Congress would make such a drastic move.

Instead, he expressed the opinion that whatever initiative changes and replaces the ACA, it would allow a gradual and lengthy transition for people and for the marketplace to cope, as well as retain the more popular aspects of the ACA.

“Since we serve individuals regardless of their ability to pay, those who may lose their coverage will still be able to receive services from us,” Harris said.

When asked the question of whether individuals suffering from mental health issues, intellectual disabilities or chemical abuse problems — the primary patient base of Spindletop — had a harder time finding adequate care than other people did, Harris answered in the affirmative for most cases.

“While the Texas Legislature has increased funding for mental health and substance abuse services in the last two sessions, Texas still ranks in the bottom 10 or so in per capita funding among the states,” Harris said.

Nevertheless, Harris made certain to credit Community Centers in Texas and the 1115 Texas Medicaid waiver for, among other things, extending funding, reducing operational costs and providing additional services for the people they serve.

According to Monique Sennet, public relations and marketing administrator for Spindletop Center, the Center serves on average 740 people a day and 3,784 people a month in the Jefferson, Hardin, Chambers and Orange Counties.

Sennet said that Spindletop Center utilizes a number of channels to reach out to the community including television and radio segments, school presentations, Chamber events, social media and billboard advertising alongside many other initiatives.