Ad-hoc organizations fill cracks that remain in health care system
Ben Allen, General Assignment Reporter | 06.05.14
(York) -- For those without health insurance, they have choices through Medicare, Medicaid, subsidies through the health insurance exchange, and Medicare Advantage. Each has different requirements –- income and age guidelines are the most basic. But the limits are rigid, leaving some gaps. So others often have to step up for those left out.
In downtown York, the Healthy Community Pharmacy distributes medication to those with prescriptions, but at minimal cost. Those making up to 300 percent of the federal poverty line are eligible – that’s about $35,000 for one person, or $72,000 for a family of four.
"These are people who are generally between 40 and 64, people who are working. We find that the majority of the households who apply for Healthy York are people who have jobs or who are on fixed incomes. Many people use us because they're underinsured," says Eve Gardner, Executive Director of Healthy York Network, which runs the pharmacy.
Healthy York Network has a wide reach for its 5,700 members, including primary care physicians, orthopedists, emergency room visits, and specialists. But it is not insurance. It’s designed to get care for those who need it and can’t afford it.
Photo by Ben Allen/witf
Applications for Healthy York Network are available in both English (pictured) and Spanish.
Says Gardner: "For instance, in a primary care practice, I've had providers say 'I really want to help that person in front of me. I've been seeing this person for ten years and they've just lost their job and they've lost their insurance. I want to keep caring for them. They have a chronic illness and I want to be able to keep doing this.''
"What it's enabled the provider to do is know that when the patient leaves their office, they're actually going to be able to follow through on getting the X-ray, on getting the medication, on getting the blood work."
At the pharmacy, around 10 people sopped by on a recent afternoon this week, picking up medications. They looked like America. Some were Caucasian, others were Hispanic or African American. However, none wanted to share their story.
"It's amazing the number of stories we’ve heard from people who've just said, I wasn't able to get that lump checked out, or I just let my diabetes go. It's amazing the number of people who just didn't put health or health care at a high priority in their lives," recounts Gardner.
She's been at Healthy York Network since it ramped up in 2003. It initially relied on federal grants, but when the funding dried up, Wellspan picked up the cost. That includes the salaries for all the administrative staff – the people who vet applications, help members navigate the system, and the pharmacists. Wellspan is supposed to provide some level of free care to maintain its nonprofit status. So is this just filling that need? Gardner remembers a conversation she had with a doctor:
Photo by Ben Allen/witf
The entrance to Healthy Community Pharmacy.
"People are going to come to our Emergency Room anyway. When someone gets sick, they're going to come. Why wouldn't I try to create a system that makes it better for them? That's in my best interest. So yes, I have to provide charity care, but why would I make it harder for myself?"
It establishes some order for Wellspan and the other health systems that participate – Memorial Hospital in York and Hanover Hospital. They all absorb the costs of care – for those making up to 200% of the federal poverty line, they foot the whole bill. Those making between 200 and 300 percent pay half of their bill.
"They can say, I can use this card, and go to the doctor and get my medication and actually feel pride. People say it's amazing that little plastic card can give me some dignity. I think it's good for the community. I honestly feel that why wouldn’t we want a healthy community? And why not a healthy community for all?" says Gardner.
Healthy York Network isn’t the only option for those in the midstate.
"An urgent medical need would be for someone who needed to see a primary care physician," says Sue Williams, who runs Health Share at Holy Spirit Hospital.
"We get them in, we can get them back on medication and help them that way. It could be a dental need where they have an absess tooth. There's not an exact definition of urgent need."
It’s not as comprehensive, serving about 150 to 200 patients a year. But it’s another program finding its in demand, despite the best efforts to get people insured. Williams says most of those coming to her are also working, but make just a little bit more than Medicaid requires. She says Health Share dates back to 1996, and is funded by Holy Spirit.
"I had the opportunity of orchestrating about 8 different physicians to provide care for a woman who had problems with a foot. She was not able to walk. And after 5 months of work, I was able to get all these physicians to provide her care for free, and actually, they fixed her foot so she can walk."
Those are the stories both Sue Williams and Eve Gardner say get lost. Their goal is to get people off the help.
As the federal penalties for staying uninsured start to climb, the missions will either change or the programs will disappear. For those involved, they hope at some point, there won’t be any more of these cracks to fill.