Caught in the middle: Eugene’s uninsured

As the health care reform battles rage both locally and nationally, Eugene’s uninsured population looks for decent medical care

By Nikki Wyatt

Eugene resident Stephanie Miller works two customer service jobs and still can’t afford health insurance. “It’s bewildering to me that if something truly awful happened, I would be in an enormous amount of debt in the very best case scenario,” she says.

The single mother of two must rely on free clinics in the area such as Whitebird and community health centers for her and her children’s care.

“I’m scared of what could happen to my daughters if something happened to me,” she says while waiting in line at Lane County’s Community Health center in downtown Springfield. Her daughters, ages 4 and 7, have only seen a pediatrician a handful of times.

“I’m scared that something could be wrong with them and I wouldn’t even know it because I don’t have regular access to a doctor.”

And she’s not the only one.

“We think there are probably 60,000 people in Lane County who do not have insurance,” said Dr. Richard Barnhart, a volunteer with Cascade Medical Team, in an interview with kmtr.com. For a metro population of nearly 300,000 people, Eugene’s uninsured comes in at about 20 percent, ranking higher than the entire state of Oregon, which had an uninsured population of almost 18 percent in 2009.

However, Lane county public health and its affiliates are working hard to provide affordable health care to those who are uninsured.

“Our business model is to serve the uninsured,” says Jeri Weeks, CEO and manager of the Community Health Centers of Lane County. Community Health Centers of Lane County, or CHC for short, was established eight years ago. Weeks, who has been with CHC for four years and has been in public health for 30, estimates that CHC serves 23,000 patients annually over four sites.

“Our goal is to provide a patient centered medical home,” Weeks says, explaining that the goals of the organization are take the burden off the emergency rooms in the city. “Homeless people, hurt people, people who don’t have anywhere else to go end up in ERs,” she says, “We take them in and provide with them the stability of having the same doctor every time.” Weeks insists that 95 percent of the time someone comes in for a second time, the patient will be able to see the doctor he or she already had. “It’s important to feel connected and it’s nice to have a doctor who knows what you need.”

The CHC services include primary care, pediatrics, endocrinology, internal medicine, prenatal care, and dental prevention, demonstrating that CHC looks to take on patients for a long time rather than the “treat and street” methods of some clinics.

While Weeks says that 35 percent of her patients do have some sort of insurance, most do not. “We see a lot of Medicare and Medicaid,” she says, “and it doesn’t cover as much as a private sector health plan.”

The Oregon Health Plan is the Medicaid program for the state of Oregon. Right now, selection is based on a lottery system with about 50,000 people competing for 3,000 annual spots. While originally praised for being a national leader in terms of health care reform, OHP is “overburdened with applicants,” says Weeks, “People are falling through the cracks.”

Aside from the idea that a lack of access to insurance is a burden to individuals and families, the impact the uninsured has on the general population is not lost on Oregon health officials. Karen Gillette, the Program Manager at Lane County Public Health, says that the “chronic disease burden to taxpayers is overwhelming.”

As a health care administrator for Lane County, Gillette sees her fair share of uninsured people not getting the treatment they need because of financial obstacles. “People come in with things that were originally minor but have escalated because they didn’t originally seek care.”

Gillette sees the health care crisis in America as a combination of cost issues and prevention issues.

“18 percent of adults in Eugene smoke,” she says, “24 percent of them are on the Oregon Health Plan.” Gillette argues that with the many diseases and health risks of tobacco, “reducing that percentage will make us see a huge shift in the amount of people who need care and make room for the uninsured to access health care.”

The connection between everyone having access to medical care and the general safety of the public is easy to discern, insists Gillette. Things like sexual health or a lack of immunizations pose a significant risk to more than just the carrier. “That’s what we offer free immunizations,” she says, “It’s about more than one person.”

To counter the never ending circle of uninsured people being unable to access the care they need and therefore burdening the rest of society with communicable diseases, Gillette works with nurse practitioners and doctors to pinpoint areas of primary prevention. “These points include things like preventing obesity by having access to healthy foods or preventing the spread of sexually transmitted diseases by promoting sexual wellness.”

Gillette looks to the broader side of health care. “It’s about taking care of the person as a whole, which will limit their need for medical care in the beginning.” She admits that, in the current state of health care reform, achieving that can be a challenge. “If you have a limited income, that’s where it really hits home,” she says, “which is why we never turn anyone away for inability to pay.”

Both Weeks and Gillette are in favor of national health care reform. Weeks recognizes that Medicaid programs don’t always cover what is needed for their patients and that “We need to make it easier for people to access the health care they need.”

Gillette is an ardent supporter of Obamacare, saying, “You can tell it’s about the people and I think that’s the direction we need to go in. We need people to take responsibility for their personal health and with that will bring a shift in the need for it in general.”

“I’ve spent my whole career working with people living in poverty.” Weeks says, “And what we have now isn’t working.”

Both of the health worker veterans acknowledge that there’s only so much they can do for their patients. Gillette is fighting to make social programs more comprehensive by providing access to prevention points rather than just treatment points and Weeks is fighting to make sure uninsured patients have access to any care they need.

While the two women do their jobs and Obama continues to fight courts on a national scale and the Oregon Health Plan keeps applicants in a lottery, people like Miller still don’t have the access to care they need. “I respect the options I have right now while I’m uninsured,” she says, “but I know that it’s only a temporary solution.”

Miller is currently in the Oregon Health Plan lottery and does everything she can do to keep her and her kids healthy. She takes full advantage of the services offered to her by the places such as the ones Weeks and Gillette manage yet still feels that it might not be enough.

“I hope that one day I won’t have to worry about it and I’ll have a stable job and it won’t cross my mind as much,” she says, looking down at her two daughters. “I hope that one day no one will have to worry about it and it will just be a given thing.”

But for now, she’ll just have to wait.

What is Obamacare?

The Patient Protection and Affordable Care Act is a federal law signed in March of 2010. The biggest stipulation of the act is in that it requires all people not insured by their employer to obtain health insurance with only exceptions granted for religious reasons or financial hardships. Citizens meeting the poverty level or in excess of 400 percent of the level are eligible for government subsidies for the purchase of insurance. Other reforms include eliminating copayments and deductibles from certain private health plans and the preexisting condition clause that some private sector companies use to avoid covering health concerns that were documented before the individual obtained insurance. Several states have challenged the constitutionality of the law, the main argument being that the government is overstepping not only on individual freedoms but also in regulating health care as a market and forcing people to enter commerce. The Supreme Court is currently hearing cases on the legality of mandating all Americans to buy health insurance and whether or not the states can continue to challenge it.

Whitebird Clinic: Low cost medical care for everyone 

Whitebird clinic is a nonprofit dedicated to improving the health and lifestyle of Eugene residents. Located on 12th and High, it operates several centers based off of services offered. It’s biggest and perhaps most recognizable program is CAHOOTS. Standing for Crisis Assistance Helping Out On The Streets, CAHOOTS will respond to any situation within Eugene city limits. The workers will respond appropriately with police or medical personnel and/or crisis counselors in preparation for psychological issues. CAHOOTS also provides transportation to social service areas such as shelters and hospitals if necessary.

Another program offered by Whitebird is Chrysalis Drug Treatment. This program is for adults struggling with substance abuse. It offers group and individual therapy and counseling, classes, screenings, and other support through innovative therapies. Low cost options are available and pay is based on a sliding scale depending on a client’s ability to pay.

Similar to CAHOOTS, the Crisis Center also provides a 24 hour hotline and emergency response to those in crisis. Counseling, transportation, mental screenings, and referrals are core elements of this program. This is an entry point into the Lane County Mental Health System.

Whitebird also provides services specialized to Eugene’s homeless population. Primary medical care, counseling and evaluation, screenings for mental illnesses and case management are among those offered. The program is operated on a walk in basis from 12-2pm every weekday.

For more information about any of the Whitebird services and programs, call 541-342-8255 for the main building and 541-687-4000 for the crisis line.

 

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