Tag: Obamacare

The Demand for Volunteer Physicians Is Rising. The Number of Uninsured Is Too

Posted on by robbie

The class and financial borders in Bridgeport, Connecticut’s largest city, are prominent. Within a 10-minute drive, the landscape in any which way can go from tidy, two-story homes with picket fences to burned-out buildings and blighted neighborhoods.
It’s this divide that has ranked Connecticut — and specifically Fairfield County — as one of the best (or worst, rather) examples of America’s wealth gap. It’s also home to more than 83,000 people who are uninsured — the leftovers from Obamacare who are either undocumented or can’t afford private health insurance.
And it’s those residents who Dr. Ken Grossman thinks about when he volunteers once a month at the Fred Weisman Americares Free Clinic in Bridgeport, about 30 minutes south of his main practice.
“There’s this paradox where we’re the richest and the poorest county in the nation,” Grossman tells NationSwell. “The population I see, they are some of the hardest working people. Some of the poorest too, but it’s because of that they take nothing for granted.”
Grossman is one of thousands of doctors that volunteer their time at free clinics, of which there are about 1,200 across the nation serving 6 million people, according to the National Association of Free and Charitable Clinics. Their mission is simple: provide free healthcare to those who can’t afford it. These medical facilities were the lifeblood for the uninsured before the Affordable Care Act. But as Medicaid expanded in 31 states, including the District of Columbia, following the law’s passage, more people were able to get coverage, leaving free clinics fighting for survival.  
Now, with national healthcare on unsteady ground, there could be more people relying on these clinics again, but there’s a dearth of skilled and well-practiced physicians willing to volunteer.
“If you ask me what I need, I’ll always tell you dollars and docs,” says Karen Gottlieb, executive director of Americares’ four free clinics in Fairfield County. “And we desperately need docs.”

Americares Free Clinics Nurse Practitioner Mary Beth Fessler takes a patient’s blood pressure at the Boehringer Ingelheim Americares Free Clinic in Danbury, Conn.

DOCTORS’ DISAPPEARING ACT

Volunteering among professionals has seen a gradual decline over the past six years, according to data from the U.S. Bureau of Labor Statistics. The percentage of volunteers with advanced education, including doctoral degrees, dropped from 42.4 percent in 2011 to 38.8 percent in 2015.
And though more than 90 percent of physicians emphasize that volunteering or community outreach is paramount for their jobs — specifically helping the poorest patients — only 39 percent have volunteered their time, according to a 2008 survey.
“Pro bono work in law is mandated, but you don’t have that in medicine,” says Yasmin Meah, founder and program director for Mount Sinai’s East Harlem Health Outreach Program, a free clinic in New York City. “A few years ago we were really struggling as far as recruiting and maintaining volunteers. We’d have to close about four to five times per year because there were no volunteer physicians.”
The decrease in volunteers has forced clinics like Meah’s to get creative in attracting doctors to donate their services. One way they’ve done so is by offering malpractice insurance for physicians, which can cost thousands of dollars a year. Americares’ clinics, for example, provides liability coverage to its volunteer doctors — an incentive that convinced Grossman to get on board.
Still, covering malpractice isn’t the answer in every case. Free clinics affiliated with hospitals, like Mount Sinai’s for example, often prefer to work with doctors who currently practice at the hospital, because their insurance is already covered. This in turn can lead clinics to pass up the services of older, retired physicians, who otherwise have the time, experience and desire to volunteer.
It’s a conundrum that’s only become more pronounced as clinics, most of which rely on a shoestring budget and bare-bones volunteer staff, struggle to stay open. After the rollout of the ACA, many had to convince donors to keep funding their operations, says Sasha Bianchi, executive director of Volunteers in Medicine.
“The challenge was the perception more than the reality of the situation,” says Bianchi. “Everybody was thinking, ‘Oh, society solved [the uninsured] problem, so I’ll send my money somewhere else.’”

DIAGNOSIS: MORE TROUBLE AHEAD

Despite the uninsured rate dipping to 9.1 percent in 2015, a record low in the U.S., there has been a slow trend upward that has many clinic leaders worried — and fighting for funding.
According to the Gallup Health Index, the uninsured population saw an increase to 11.7 percent in the second quarter of 2017. The reasons behind the uptick are numerous: insurers leaving the ACA, higher premiums and an uncertainty of where the law will go under the current administration.
But that could all change, for the worse, as higher premiums proposed next year push more people back into the uninsured ranks. In June of this year, the two companies in Connecticut selling individual plans through the ACA — Anthem and ConnectiCare — have both proposed rate increases for 2018, ranging from 17.5 to 33.8 percent.
And Americares’ clinics won’t be able to treat everyone, says Gottlieb.
“We’re only taking care of 3,200 of them, and there are a lot more people out there who don’t have insurance,” says Gottlieb. “We could see more patients if we had more resources, but we are resource-constrained.”

‘I’M GOING TO HELP THEM’

For those clinics that didn’t close their doors, they became de facto medical homes or navigation facilities. And many were able to rise to the challenge as demand fell and patients were able to be seen faster and more frequently.
Which is all good news, as free clinics also provide a training ground for medical students. At the East Harlem Health Outreach Program, any given Saturday will see 35 volunteer med students working, all of whom get to see the troubles facing a beleaguered population whose health is sometimes made critical by lack of consistent or quality healthcare.
It’s that same population, about a quarter of which are immigrants, that Grossman, the Americares volunteer, loves to help, despite the political arguments against the undocumented and their use of the healthcare system.
“I became a physician to take care of people,” he says. “These are people. They have hearts, arms, brains and medical issues, just like everyone else. And I’m going to help them.”

Maryland’s Public Experiment to Combat Poverty and End Obesity

Posted on by robbie

In parts of Maryland, when poverty rates rise, so do healthcare costs — a correlation that’s not uncommon across the country.
In response, the Affordable Care Act carved out a portion of its budget to support communities promoting nutrition and exercise, while reducing obesity and tobacco use. Called the Prevention and Public Health Fund, it aims at not only getting Americans healthier, but also quelling healthcare and hospital costs through preventative measures.

It’s estimated that up to 40 percent of deaths each year from the five leading causes — heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries — are preventable, according to the Centers for Disease Control and Prevention.

MORE: These Pharmacists Are Making Affordable Medication for All a Reality

In Maryland, preventative care exploration has been underway since the 1970s, but thanks to the new funding from Obamacare, state officials have revitalized a plan to get its residents healthy.

The western Maryland city of Cumberland has one of the greatest needs for preventative care. The area, with a population of about 20,000, has notched an obesity rate of nearly 29 percent. The surrounding area of Allegany County carries a poverty rate of 16 percent, leading to poor nutrition practices, food insecurity, and often, costly hospital visits.

But Western Maryland Health Systems (WMHS) is tapping into federal funds to transition medical practices out of a traditional fee-for-service model that reimburses doctors and hospitals for each test, treatment, and medication. As critics of fee-for-service have noted, this model can lead to unnecessary treatments or substandard care which prompts further treatment. Instead, WMHS will help doctors cap and stabilize reimbursements through Medicare and Medicaid, encouraging hospitals to use more preventative care methods to keep their patients healthy, according to the American Prospect.

Perhaps the more interesting part of the state’s initiative is the community outreach teams that will visit the homes of patients with conditions like asthma or diabetes to ensure they’re taking medicine and heeding a doctor’s advice.

“If you begin to work on controlling the healthcare spending in an area, you have to be able to confront and understand some of those social determinants of health,” said John M. Colmers, chairman of the state’s Health Services Cost Review Commission and a vice president at Johns Hopkins Medicine.

A variety of organizations across the state are pitching in to help low-income families find better sources of nutrition and increase exercise. The University of Maryland’s extension office for Allegany County has implemented educational programs for families while passing out healthy recipes and helping out at local food banks. Two of its staff, Katheryn Kinsman and Eileen Morgan, have been working with local families for 26 years.

Their biggest challenge, according to Morgan, is getting inside the home.

“There is an extreme amount of pride here, and just forming any kind of rapport here is hard,” Morgan told American Prospect. “Just getting in the door is hard.”

Apart from pride, the poverty rate has directly contributed to the area’s poor health — common afflictions include obesity, asthma, and untreated mental illness. To combat obesity, Morgan and Kinsman use simple methods like teaching how to prepare nutritious meals, learning to chop and stir, and finding sources of fresh fruit and vegetables. The two recalled buying clients a pot and wooden spoon before teaching a class.

“If you’re a mom with very little resources and several kids, and you go into the market and you can get a box of 12 cupcakes for a dollar, while apples are a dollar apiece, which are you going to buy?” Kinsman said.

Even finding an area to exercise poses a problem for Cumberland, which is why the local extension office offers an exercise class at the community center.

But with renewed attention and funds to promote healthy living, state officials are hopeful to turn the tide in Cumberland and Allegany County.