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Changes in Subsidized Medical Care May Produce Greater Burden on Community ClinicsJuly 16, 2003Doug: In January, thousands of poor families in Washington may face a tough decision: start paying monthly premiums for subsidized health insurance for their children or give up their coverage, which, for years, has been free.Charlene Fisher says she and her husband, who make less than 900-dollars-a-month between them, would have a tough time paying even 15-dollars-a-month for insurance for her 13-year-old nephew. Charlene Fisher “That would mean 15-dollars out of the grocery money, flat out, or any of the necessities that we need in the house, like shampoos; my odds and ends money is what I call it.” Doug: State officials say they can now only afford to provide free coverage to children in the poorest families, those who make less than the federal poverty level, about 18-thousand dollars a year for a family of four. Those who make more would pay tiered premiums, 15, 20 or 25-dollars a month per child, up to three children. All of this depends on the federal government giving the state permission to impose premiums. It’s likely the Fishers’ income is low enough to allow them to keep the free care. But even if it’s not, Fisher says she wouldn’t dare drop her nephew’s coverage. Fisher “Well, in his particular case, I couldn’t because of medications that he’s on and the counseling that he goes to and his regular doctor’s appointments, I’d have to keep it. Because it’s either you do that or you’re forced to pay the full medical expense.” Doug: Others will make a different decision. Some will drop their insurance, cross their fingers and hope their children don’t need it. We met Charlene Fisher at the Christ Clinic, tucked away in one end of the Westminster Presbyterian Church in Spokane’s West Central neighborhood. The clinic caters to low-income people, people on Medicaid, people with no insurance. Office Manager Connie Malone predicts the state’s new policy will add to the clinic’s business. Connie Malone “We already turn away five to eight, on average, phone calls from people we don’t have room to see, that are already in that situation, that we already refer to all the other clinics in town, in hopes that they can get in sooner than we get ‘em in, which is typically two weeks right now.” Doug: Some of those people turn to CHAS (chazz), the Community Health Association of Spokane. C-E-O Peg Hopkins says, five years ago, CHAS saw fewer than a thousand patients a year. Peg Hopkins “We are gonna see 70-thousand patients this year.” Doug: CHAS now has four clinics, one downtown, one in the valley and two on the northside. For the last five years, she says, only 20-to-25-percent of the CHAS patients have not had some form of medical insurance. But that percentage is increasing. Hopkins “Since the beginning of this year, in January, our ratio of uninsured is now over 40-percent. So we’re absolutely seeing a dramatic shift, and it’s quite dramatic if you look at that data over all those years of it not changing, no matter what the economy was. All of a sudden it’s really changing.” Doug: Hopkins believes the number of uninsured will continue to climb. And she says, as more people lose their insurance, fewer will seek health care, because private clinics won’t see them. Hopkins “Many people have been refused care because they say they’re gonna pay cash, because providers know that the condition may require specialty and hospitalization and they know cash isn’t gonna cover it. So, they say we can’t see you.” Doug: That rejection, Hopkins says, turns people away from the medical system as a whole, even away from community clinics like hers that will see patients that don’t have insurance. Moms and dads who have been rejected sometimes will give up on doctors, until a serious situation forces them to bring a child to a hospital emergency room, which must, by law, see that child, regardless of the family’s financial situation. Margaret Bruya (broo’-yay) from Spokane’s Intercollegiate College of Nursing says, in turn, that will put a huge financial burden on the region’s hospitals, which will have to shift the costs to their other patients. Bruya says clinics like hers, the People’s Clinic, on the second floor of the Y-W-C-A, can take some of the burden now borne by the hospitals. The clinic is operated by the College of Nursing and part of its role is to give nursing students the chance to see patients. Margaret Bruya “I hope we get more kids. I’d like to be able to serve those children. We’re prepared to do so. We have the staff. We have the ability to see children. We have the skills to see children. And we are set up with grants to help pay the bills.” Doug: That means the People’s Clinic can afford to take only a few dollars from poor families that might not otherwise visit a doctor. The College of Nursing has several private donors, including the Robert Wood Johnson Foundation, which has given one-point-eight million dollars for the People’s Clinic and other projects. One of those projects is the Ronald McDonald Care Mobile. The care mobile is a huge bus, built with two examining rooms, including one with a dentist’s chair. (sound of girl getting an eye exam, covering her eye and saying letters) Doug: Abigail Smith is having her eyes checked. She’s standing in one end of the Care Mobile with an eye covered and she’s peering the length of the bus to an eye chart on the far end. The bus is parked in the lot at Windsor Elementary near Cheney. Abigail’s mother, Mary, the wife of a retired military man, brought her daughter and two teenage sons for checkups. Mary Smith “Because it’s two miles from my house, rather than driving all the way out to the base, which is 20 miles roundtrip for me. If you can all three done at the same time, that is just really helpful.” Doug: The Ronald McDonald Care Mobile spends several days each week in school parking lots and at shopping and community centers. Nurse Practitioner Sandy Forsman says it takes health care to families like the Smiths, which have insurance, and to families that don’t. Sandy Forsman “If there is insurance that can be billed, we certainly will go ahead and bill that. But if there is no health insurance, that’s really our main goal, is to get those kids the health care they need when they don’t have the resources to do it on their own.” Doug: With governments, especially state and local governments, struggling for funding, it may be that private sources will bear more of the burden of helping poor families get health care. And it may be that new approaches, like the Ronald McDonald Care Mobile, that bring care to the community, will become the normal way of providing care for poor people. For “Growing Up Healthy”, I’m Doug Nadvornick. By Doug Nadvornick 
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