Break out session at Clementines
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Topic: Access to Healthcare for the Uninsured
Location: Clementines
Convened: 10:30
Attendees and Affiliations:
Keith Gnagey; Chris Nye; Bernie Mathes; Stan Farthing; Debbie Bullis; Tom Pike; Christopher Nye; Kim Whetzel; Richard Baugh; Alan Finks; Tim Ruebke; Bruce Lundeen; April Hedrick; Stephanie Reese;
Notes:
Free Clinic serves only uninsured residents of Harrisonburg/Rockingham County who are under 200% of the Federal Poverty Guidelines (FPG) and have an ongoing medical condition. FC supported by local donors and volunteers. Care is free at the Clinic, except for a $3 donation for each medication.
Community Health Center sees patients with insurance, Medicaid, Medicare, and without insurance. Patients pay a sliding fee if income less than 200% FPG. CHC supported by federal grants (received 1 of 40 grants out of 420 applications.) CHC looking for larger facility.
Both agencies currently have a wait time for initial appointments of about six weeks. “No-show” patients are a problem for many providers who serve low-income patients, including CHC and Health Department as well as private physicians.
9500 people in H’burg and 11,000 in Rockingham County do not have health insurance. Our rate of uninsured (~28%) is the highest in the state. Health care for uninsured under 200% of FPG is challenging, but there are some resources.
No assistance for those OVER 200% FPG who have lost their insurance.
If we go to universal coverage, will the overall cost of health care be less because people will access health care sooner? Some felt no, because the system is set up to reimburse for procedures rather than primary care. Perhaps the incentive system is wrong? Procedures funded rather than outcomes. There also is a shortage of primary care providers. Is lack of insurance a choice or is insurance inaccessible? Insurance too expensive for many individuals, especially if they have a preexisting condition. For those people, costs to self-insure can be $1500 per month; one couple paid $34,000 per year after wife’s heart attack. Cost of medical care is increased by 31-36% due to paperwork and appeals required for insurance.
Are we over-prescribing pain medications? We’re seeing a lot of substance abuse and drug-seeking behaviors. If medical care is evaluated on client satisfaction, there is incentive to prescribe pain medication. It is also a faster way to serve patients than exploring other interventions.
Where are the gaps in our current local efforts to provide health care to the uninsured or under-insured?
- Mental health services
- Substance abuse services
- Transportation to medical services
- Care for those over 200% of poverty guidelines
- Care for undocumented pregnant teens, and other undocumented patients
- There are cultural roadblocks to accessing care and issues of trust in doctors.
- Getting information to citizens about what is available.
Contacts:
Keith Gnagey, H-R Free Clinic
Christopher Nye, Harrisonburg Community Health Center
