I FEEL SHEILA'S PAIN.
Until recently, Sheila (not her real name) had health insurance with Blue Cross/Blue Shield of Georgia through her job. However, the company she works for says it can no longer afford large health insurance premiums, so they’re going to a different company.
“They told us it would be much cheaper, with a big savings on our paychecks,” Sheila fumes. “But I’m only saving about $1 a week.”
The really bad news is that if Sheila ever needs to use her health insurance, she may be out of luck. Her deductible went from $500 per person to — are you ready? — $5,000. Yes, a ten-fold increase.
As a result, Sheila is spending a big chunk of her paycheck for virtually nothing. “I thought the $500 deductible was too much, but this?” she says. “Yet I’m afraid not to have any health coverage at all.”
In a flash, Sheila joined the ranks of the underinsured. But since she’s just in her 30s and so far is healthy, she’s hoping to avoid health care costs.
Or course, if something really dire does happen, she has some coverage — sort of. Consider the plight of the uninsured.
Les is by no means homeless. He has an apartment and pays his rent on time.
He has a job, but it doesn’t offer health insurance. Les, who is divorced and in his mid-50s, has multiple illnesses, including heart disease and emphysema. He also has knee problems, which make standing and walking difficult.
Because he has no health insurance, Les must go to free clinics for his primary health care. That means sometimes waiting for weeks until the doctor he needs to see will be at the clinic or, if the problem is potentially life-threatening, a visit to the emergency room, which is very expensive.
Far too often, Les has to wait to get his prescriptions filled. One time, a doctor prescribed pain medication when Les had minor surgery, but he had to tough it out because he didn’t have the money.
“Some of that medicine I take I need just to live,” Les says. “But sometimes I can’t even afford that.”
Because of his many ailments, Les misses a lot of work. He probably would qualify for Social Security Disability, but has no support system in place to help him get through the three-year waiting period it takes just to get a hearing date.
Les is a proud man, a Vietnam veteran who has worked hard his entire life. He doesn’t want a hand-out, but it’s getting harder for him to get by, paycheck to paycheck.
I myself have health insurance through the company that owns Connect Savannah, but it doesn’t begin to cover all health care costs. All the medical miracles in the world won’t help if you can’t afford them.
The number of uninsured and underinsured in this country has been growing for years. This has caused major problems, many financial, for health care providers, problems that will only grow as Baby Boomers get older.
With 45,000 residents without health insurance, Chatham County already is hard-hit. Health care providers are working to find ways to treat patients without breaking them — or the health care systems that serve them.
From its beginning as a shelter for homeless men, Union Mission, Inc. has grown to become a full-fledged health care campus that serves the uninsured and underinsured, as well as the poor and homeless. While it still provides services to the homeless, its main focus has shifted.
“We’re doing something here that to the best of our knowledge hasn’t been done anywhere else,” the Rev. Micheal Elliott, president and CEO at Union Mission, says. “We’ve created a multi-disciplinary health care facility. Other people in other places have developed pieces, but it’s our understanding that no one else is putting all of it under one roof.”
Today, Union Mission is the county’s largest provider of health care services after the Memorial Health and St. Joseph’s/Candler health systems. There are four buildings in all — the Health Promotion/Disease Prevention Center, the J.C. Lewis Health Center, the J.C. Lewis Behavioral Health Center and the building that houses not only Union Mission’s administrative offices, but also eight apartments housing 16 people who are in long-term treatment.
People who have no insurance or are underinsured can receive medical care, screenings, prescriptions, dental care, treatment for addictions, counseling — the list of services goes on and on. “What started out as a little program for homeless folks has become a cutting-edge provider for health care for the poor and uninsured,” Elliott says.
Through a partnership with Memorial Health, Union Mission is planning to open a second clinic in July at 5205 Frederick St. “We’re looking at expanding our point of access,” Elliott says. “We’re working to open a new clinic between Candler and Memorial hospitals.
“Memorial owns the site, which used to be two different physician practices. We will make it into one center for folks mostly in the 31404 and 31406 zip codes.”
Memorial Health has pledged $250,000 towards the $7 million cost. The United Way of the Coastal Empire also is helping by committing to $100,000 a year for three years.
According to the U.S. Census Bureau, 15.8 percent of all Americans are uninsured. The state’s rate is higher than the national rate at 17.5 percent. But in Chatham County, the rate is a staggering 25 percent of the total population.
“The Memorial Hospital emergency room was built for 45,000 users, yet 90,000 people are using it,” Elliott says. “Part of it is because we have a service economy, so a lot of workers don’t have access to health insurance.”
Elliott says if you don’t have a primary physician, you might wait until you’re in the worst possible condition to go in for treatment. “That means you’ll need more expensive care. It’s a worst-case scenario. We want to establish a new source of health care that is affordable and holistic.”
Other health care professionals are needed in addition to doctors and nurses. “About 40 percent of people who go to the emergency room for treatment have a behavioral health issue,” Elliott says. “The No. 6 reason people go to the emergency room is oral health. They wait until a tooth is abcessing to go for help, even though there are no dentists in the emergency room.”
Union Mission still has an emergency shelter. “It’s for people who are sick and need shelter, but need supervised shelter,” Elliott says. “It’s the kind the Salvation Army and city shelters can’t do because they don’t have therapists on site like we do.”
The new disease prevention center provides patient education. “We teach people about their own health,” Elliott says. “They learn how to take care of themselves, such as learning about managing diabetes.”
With more medical education, there is less need for medical care. Elliott says it’s obvious the program is working.
“Two years ago, we had 1,600 people who came 14,000 times,” he says. “Last year it was 3,400 people who came 12,000 times. We’re teaching people who in the past probably never had anyone to teach them.”
The behavioral health center provides 20 patient offices and 16 group rooms where more than 200 patients a day can be seen. There also are lecture halls that can accommodate 100 people.
Aretha Jones is in charge of the health programs at Union Mission. Elliott says the Frederick Street clinic “is her baby,” and she is busy getting things ready.
“We’re getting the community to understand there is a need for new provider,” Jones says. “We want people to understand Union Mission is not for the homeless only.”
Dodie Simmons is the head nurse at the J.C. Lewis Health Center. “We see people when they’re sicker,” she says. “We see a lot of diabetes. A huge part of what I do involves teaching. I tell them about the disease process, the importance of getting healthy meals, how to take care of themselves, to make sure they get enough rest.”
Many patients who are seen are given prescriptions, and Union Mission has its own medical distribution center. “We try to help clients who have no insurance and limited income,” says Kendra Aubuchon, LPN. “They bring me a prescription from our doctors and I fill it. I also take care of patients who don’t qualify for Patient Assistance,” she says. “Clients are charged $10 unless the medicine costs less than $10. They come back every 30 days, if they take their medicine on schedule, and we monitor the side effects. This is a good way to make sure their medication is helping and that they’re okay.”
Dental care is available at Union Mission. Patients are charged according to a sliding fee. “It’s based on income, so they must prove their income at the time of their visit,” says Latrell Davis. “The first X-ray and exam costs $25. If there is any additional work that is needed, the doctor will go over it with them and tell them how much it’s going to cost.”
Union Mission’s dental director is Dr. Tomoral Sams. Homeless patients who can’t pay are scheduled to be seen by dentists from the community who volunteer at the clinic.
Hart Williford, senior vice president at Memorial Health, says the Frederick Street clinic is needed, even though there are many good clinics already in existence. “The good news is we’ve been proactive in building a safety net organization,” he says. “But we still don’t have enough.”
According to figures provided by Memorial Health, there were 82,395 visits to its emergency department in 2006. Of those patients, 87 percent weren’t admitted to the hospital and 51 percent of those visits were considered non-urgent.
“If you go to St. Joseph’s/Candler, you’ll find the same thing,” Elliott says. “The key is keeping the emergency room for urgent care, for true emergencies.
“Definitely each year it seem more and more people are coming to the emergency room for primary care,” he says. “Many are very, very low income. Many are uninsured or underinsured. They end up with a significant medical bill because they can’t make the deductible.”
People with high bills and no money can’t pay and the hospitals must absorb the cost. “We’re seeing a lot of people who are being taken off the Medicaid rolls,” Williford says.
“There are a lot of reasons there are more uninsured, but the number is definitely growing. They have the same need for primary health care, but there are a number of issues that keep them from going to the doctor. They wait until there’s an emergency to go.
“For example, consider a female, pregnant, who doesn’t go to the doctor, not even to get vitamins,” he says. “She waits until she’s in the emergency room in bad shape. Education is a big piece of it. We must teach people there are places they can go and receive good primary care.”
While many visits to the emergency department are for minor ailments, Williford is quick to say that someone with a true emergency shouldn’t hesitate to seek help. “I want to emphasize that when someone has an emergency, we want them to come to the emergency room,” he says.
Paul Hinchey, president and CEO of St. Joseph’s/Candler, says he’s glad the new clinic will be opened. “I think any organization with the capacity to help people not use emergency rooms for primary care can only be a good thing,” he says. “Emergency rooms are geared toward acute emergencies. Patients who use them for primary care don’t get the continuous care one needs to stay healthy. They’re probably seeing the doctor for the first time. Someone needs to monitor the patient for overall good health.”
As at other hospitals, more people are using the emergency departments at Candler and St. Joseph’s. “We are seeing an increase, not to the extent some other hospitals are, but we are seeing an increase,” Hinchey says. “I think it happens because people use the emergency room for primary care for certain reasons.
“There are those who use the emergency department for primary care because they’ve always done so,” he says. “Then there are those who are uninsured or underinsured and think that’s their only option.
“Some people can’t afford health insurance based on what they’re paid,” Hinchey says. “Many of the companies moving into Savannah, particularly the fast-food area, don’t offer health insurance at a comparable rate so people can buy it.”
People with catastrophic health insurance risk financial ruin. “They’re just rolling the dice, counting on the fact that they’re not going to be sick that year,” Hinchey says. “You see this a lot of with single people,” he says. “They count on the fact that they’re young and healthy and won’t need health care.”
Hinchey says there are several options that should be tried to alleviate the problems. “About 80 percent of the employment market in Savannah has less than 100 employees,” he says. “Until recently there was no health insurance geared toward smaller employers. Most were geared toward larger employers. That’s changed in the last 12 months.”
Some companies can’t afford health insurance. “It’s expensive to offer health insurance to people,” Hinchey says. “If there is a high turnover rate in the company, it may not be in the best interest of the company to offer insurance. Many companies say they want people to work for them five, 10, more years. They see the importance of providing health insurance to employees.
“We need to have some type of tax incentive for small employees to offer health insurance,” Hinchey says. “Those options should be explored first.”
St. Joseph/Candler has two clinics that provide services to the uninsured and underinsured, including St. Mary’s Community Center in Cuyler-Brownsville. “We just opened another one in Garden City,” Hinchey says.
St. Joseph/Candler also provides numerous free screenings and services. “What we’ve learned is if you want patients to take advantage of the services you provide, then put them in the neighborhoods where the people live,” Hinchey says.
At one point, free screenings including mammograms and prostate exams, were offered at Candler and St.Joseph’s, but low income patients didn’t take advantage of them as much as expected. “Many people don’t have transportation,” Hinchey says. “We decided to go out into the neighborhoods where people are.”
Elliott is convinced even more people would utilize Union Mission’s services if they realized they could.
“Union Mission for 20 years has been so successful in helping the homeless that we have a branding issue,” he says. “We’re victims of our success.”
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