Health is More Than a New Year’s Resolution

If you’re one of the more than 10 million Americans who have signed up for health care coverage under the federal Affordable Care Act, otherwise known as Obamacare, you’re aware of the benefits now available to you that were previously out of reach financially. Until Feb. 15, enrollment for new plans is open for many who missed earlier opportunities and now wish to enroll and avoid fines.

In Kansas City, Kan., and Kansas City, Mo., great resources are available for anyone in the LGBT community who has questions about enrolling for health care through the ACA (see this article’s sidebar). More needs and health-care issues will arise in the community as more gay and lesbian same-sex couples become legally married and many have children who need coverage.

The Kansas City Health Department, under the direction of physician Rex Archer, has led the way in providing health services for individuals and families in the area.

With the assistance of Bill Snook (see Camp10 on pages 20-21) and in conjunction with the former Lesbian and Gay Community Center under Jamie Rich, the Health Department ran two successful LGBT health surveys, in 2004 (“Take the Pulse”) and 2006 (“Check the Pulse”), that provided health data about this specific community.

Recently Camp spoke with Frank E. Thompson, manager of the HIV Services Program, and Tiffany H. Wilkinson, acting division manager in communicable disease prevention, about health concerns affecting Kansas Citians, including the LGBT community.

Thompson gave an excellent presentation at the Dec. 1 World AIDS Day luncheon at the Kauffman Foundation about the Kansas City 2013 Epidemiologic Profile. He and Tynisha C. Gantt, epidemiology specialist in communicable disease prevention for the Health Department, collaborated on the presentation.

The data showed that Kansas City is leading the nation in the percentage of people living with HIV/AIDS undergoing treatment in the last 18 months. Of the 3,805 people in the 11-county Transitional Grant Area (TGA) who are living with HIV/AIDS, 86 percent, or 3,273 people, have been in care in the last 18 months.
11-County Area (TGA)
2013 Annual Reported Case Rate
County Population* Cases Rate**
Jackson 705,708 126 17.9
Clay 228,358 6 2.6
Platte 90,688 7 7.7
Cass 100,184 7 7.0
Ray 23,358 0 0.0
Clinton 21,002 0 0.0
Lafayette 32,572 0 0.0
Johnson 542,737 42 7.7
Wyandotte 155,085 18 11.6
Leavenworth 75,227 5 6.6
Miami 30,969 0 0.0
Total 2,005,888 211 10.5
*Table 1. Annual Estimates of the Resident Population for Counties of Missouri and Kansas; April 1, 2000 to July 1, 2009; U.S.Census Bureau, Population Division; released March 2010
Reported Cases as of 12/31/2013
**Rate per 100,000 population
The percentages of the population by race and gender are:
In Primary Care (3,805)
30% Black Male, 11% Black Female
46% White Male, 5% White Female
6% Hispanic Male, 1% Hispanic Female
1% Other Male
No care in 12 months (448)
27% Black Male, 12% Black Female.
49% White Male, 5% White Female.
5% Hispanic Male, 0% Hispanic Female
1% Other Male
Never in Care (84)
40% Black Male, 12% Black Female
36% White Male, 4% White Female
7% Hispanic Male, 1% Hispanic Female
“We have staff specifically assigned to those individuals, who actually contact and try and track down and find out what is going on with those individuals on why they are not going into care or why they have left care,” said Wilkinson.

“Every year, we do basically a 12-month look back on who hasn’t been in care, and some have been on the previous year’s list and some are new,” said Thompson. “So we’ve started looking at 18 months out and 24 months out, and ideally, although we want people getting that care every year, they may be at 14 or 15 months.”

“A lot of times we find that they’ve moved out of the area or just decided not to get treatment for whatever reason,” said Wilkinson.

“It may have been a surveillance issue or a physician not reporting on time,” said Thompson. He said that care is not dependent simply on grants and that the AIDS service providers in Kansas have a great infrastructure for assistance. “If someone wants care, they can get into care.”

Both Wilkinson and Thompson said the Affordable Care Act, which increased the number of people who are insured, may affect data in 2014 and 2015, but there won’t be data on 2014 trends until mid-year 2015.

“It’s presented … usually in June, so it’s usually six or seven months until we get the previous year’s data,” said Wilkinson.

The ACA is “making a real difference in terms of the funding” said Thompson. “It’s one of the things that the Ryan White Act is working through and seeing what services are provided with those funds. Because traditionally we pay for the medical care while our costs for health insurance are going up but our costs for oral health and medical care are going down.

“Folks getting tested and getting into care early makes all the difference in the world.”

Another element that Wilkinson’s job covers in communicable diseases is the flu.

“It’s still not too late to get your flu vaccine,” said Wilkinson. “If you have Medicare or Medicaid, we will bill for you, with no cost to the client. For children or anybody under the age of 19 who have Medicaid or are uninsured or underinsured, we have federal qualified vaccines called VFC … that is available for free.”

The Health Department offers flu shots for $25 at a walk-in clinic. Hours are 8-11:30 a.m. and 1-4 p.m. Mondays, Tuesdays, Wednesdays and Fridays, and 8 a.m.-1 p.m. Thursdays (registration closes at 12:30 p.m. on Thursdays). Travel immunizations are available by appointment only at 816-513-6128.

Flu vaccine manufacturing begins in the spring for the following winter, so public health officials have to decide months ahead of time which strains to include in the vaccine.

The strain that now seems predominant in the United States, Wilkinson said, “is not perfectly matching what we see in our current vaccination. That said, we have two or three other strains in our current vaccine that match what is going around and can protect you from those strains. It still might offer some protection and lessen the severity of the flu. So it’s really important and very helpful to get a vaccine and protect those around you.

“We haven’t hit the peak yet and it takes a couple of weeks to build immunity so there is still time to get the shot and get it into your system.”
Resources:
General topics
PROMO’s information on LGBT health in Missouri: PROMO
The Affordable Care Act and LGBT: Out2Enroll
HealthCare.gov &amp

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