The commodity in the Livestock Exchange Building today is health care, and business is swelling.
The historic building houses OneWorld Community Health Centers' headquarters and main clinic, but patient volume is so great that the federally supported health clinic is erecting two more buildings at its South Omaha campus and adding a site in west Omaha.
OneWorld's number of patients more than doubled from 2006 through 2011, fueled by growth in the area's low-income population. The increase also reflects the fact that Douglas County's burgeoning Spanish-speaking population feels at ease at the center, where most employees are bilingual.
Also contributing to the growth — which outpaced that of other community health centers in Nebraska during those six years — was the clinic's increased visibility since moving to the Livestock Exchange Building in 2005.
OneWorld's expansion has occurred in part with money from the federal Affordable Care Act. The law allocates $11ábillion nationwide for expansion and operating funds for community health centers to serve the millions of additional patients expected to seek care after they acquire Medicaid or other insurance under the legislation.
It's unclear how many more patients the law will help serve in Nebraska and Iowa, because Govs. Dave Heineman and Terry Branstad oppose the expansion of Medicaid. The expansion is voluntary for states under a June ruling by the U.S. Supreme Court.
Nonetheless, OneWorld, which exists largely to serve low-income and uninsured patients, already has a big, growing pool of people likely to use its primary care and dental and mental health services.
“The people that are really struggling are our target and the purpose behind community health centers,” said Andrea Skolkin, OneWorld CEO. “The good news is people are getting health care.”
Federal community health centers charge their patients on a sliding scale based on income. There are more than 1,200 community health centers in the country, including six in Nebraska and 14 in Iowa.
Officials with two central Nebraska health departments hope to open a community health center in Grand Island. They are among more than 500 making such applications, however, and the president's budget request for this fiscal year calls for only 25 — brand-new centers, or new sites opened by existing centers.
As a key local provider to low-income patients, OneWorld's numbers have gone up as the poverty rate has increased in Douglas County, including its home base in South Omaha.
The poverty rate in Douglas County rose from 9.8 percent in 2000 to 14.8 percent in 2011. In South Omaha's main census tracts, the rate went from 16.5 percent in 2000 to 22.2 percent in the five-year period ending in 2010, according to David Drozd, census expert at the University of Nebraska at Omaha's Center for Public Affairs Research.
Countywide, he said, the Hispanic population rose nearly 87ápercent, from 30,928 in 2000 to 57,804 in 2010 — a significant surge, because the bulk of OneWorld's patients are Hispanic.
One recent evening, a line of women and families extended beyond the north doors at OneWorld. The special women's night included blood pressure checks, breast exams, flu shots, and demonstrations of Zumba fitness dancing and cooking.
Maria Elena Ramirez's eyes welled with tears when she talked about what OneWorld has meant to her and her mother, Marcelina Alcantara, 74.
“In other places they charge her a lot more,” Ramirez said through her daughter, Yesenia Valenzuela, who interpreted Ramirez's Spanish.
OneWorld employee Emily Sutton helped Alcantara weave through the bureaucratic tangle and provide the information necessary for the elderly woman to receive Medicaid.
Then Alcantara could afford cataract surgery and medications to control her blood pressure, cholesterol and diabetes. Alcantara and Sutton became friends in the process.
As Alcantara walked past Sutton during the women's clinic, she put a hand out and touched Sutton on the arm — a sign of affection in any language.
“She'd like to thank OneWorld,” Ramirez said of her mother.
Jorge Espejel, Mexican consul in Omaha, stopped by the women's clinic. “Excellent organization,” Espejel said.
His presence at the event was an acknowledgment that OneWorld serves thousands of Latinos. Skolkin said about 80 percent of OneWorld's patients are Hispanic.
In 2005, OneWorld moved from space in a South Omaha strip mall to the first three floors of the Livestock Exchange Building, one of the main landmarks in the southeast part of the city.
OneWorld displays in its hallways framed photos of the building and Omaha Stockyards during South Omaha's great meatpacking era. The checkered tile floor on the second level is the same one that ranchers and livestock buyers once walked on.
Three years after moving into the building, OneWorld opened Cass Family Medicine in Plattsmouth, Neb. That clinic adds about 2,500 patients to OneWorld's volume.
Skolkin said OneWorld opened the Plattsmouth clinic because there was a need for more primary care service there, and OneWorld wanted to serve its low-income population.
But the South Omaha clinic is still the center's primary location.
Ledy Davidson accompanied a toddler cousin to OneWorld about 10 years ago, thinking she could help interpret for her cousin's mother from Honduras. Davidson quickly realized that her help wasn't needed because so many of OneWorld's staffers speak Spanish.
Davidson also noticed that OneWorld, which was in smaller quarters near 36th and Q Streets at the time, was crowded but that patients were treated with dignity.
So when Davidson needed a family practice rotation, or internship, for her physician assistant program, she obtained it this year at OneWorld.
“I knew right away on the first day that this was the place that I belonged,” Davidson, 28, said. “I think I knew within an hour.”
Davidson, now a full-time physician assistant at OneWorld, said the center has succeeded in providing quality care through respectful practitioners and staffers.
“We have gained the trust of our patients,” she said.
World-Herald staff writer Bob Glissmann and researcher Jeanne Hauser contributed to this report.
Health care centers count on backing by politicians
The Affordable Care Act would distribute $11 billion over five years to federal community health centers.
Congress already typically distributes about $2.2 billion a year to the program. The additional money anticipates that 20 million more newly insured patients will receive health care at the centers.
Less than half of the $11 billion has been distributed.
Republican presidential candidate Mitt Romney has pledged to repeal the federal health care law, but the National Association of Community Health Centers nevertheless hopes that if Romney were to be elected, at least some of the remaining money would still go to community health centers.
Amy Simmons, the association's spokeswoman, said the centers generally have had bipartisan support. A new bipartisan Senate Community Health Centers Caucus in July pledged in a letter to “support and promote policies that preserve and expand access to primary health care” for those who rely on the centers.
Community health center projects in Nebraska that have received money from the Affordable Care Act:
╗ OneWorld, $8.9 million toward a $16.7 million project to erect two new buildings on its South Omaha campus; $150,000 toward the opening of a west Omaha clinic early next year.
╗ Charles Drew Health Center in north Omaha, $477,000, for primary care services at four Omaha Housing Authority sites; $78,000 to divert homeless people from seeking primary care in emergency rooms.
╗ Good Neighbor Community Health Center in Columbus, Neb., $5 million this year to erect a new building.
╗ The six centers in Nebraska and 12 of the 14 in Iowa have received $55,000 each ($990,000 total) to create medical homes, where patients with chronic diseases such as diabetes are regularly contacted to make sure they are taking their medications, seeing their doctors and monitoring their conditions.
Expanding to meet growing west Omaha need
OneWorld Community Health Centers is more than a South Omaha institution. The federally funded health care agency, which opened a Plattsmouth, Neb., clinic four years ago, plans to add a clinic in west Omaha early next year.
Forty percent of OneWorld's patients live outside South Omaha, said Andrea Skolkin, OneWorld's CEO. “They're from everywhere,” Skolkin said.
OneWorld typically serves low-income and uninsured patients, and the number of impoverished people in west Omaha is growing.
David Drozd, census expert at the University of Nebraska at Omaha's Center for Public Affairs Research, said that in 2000, none of the census tracts, or neighborhoods, west of 90th Street had a poverty rate of 15 percent or more of its residents.
In the five-year stretch ending in 2010, eight of those tracts had poverty rates of at least 15 percent.
“It is rising in most parts of the county,” Drozd said.
The west Omaha clinic, at 4101 S. 120th St., will contain nine medical exam rooms and, eventually, five dental rooms. The one-story brick building stands just south of the Under the Sink special waste facility and is on the north edge of the Sports Plaza shopping area.
Skolkin said the approximately $600,000 renovation project will be covered at least in part by federal stimulus and Affordable Care Act money. She hopes the project is completed in February.
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