Reflections as our 20th Anniversary Approaches

Mercy Health Clinic began serving the uninsured poor of Montgomery County on October 3, 2000.  On that first day, the clinic saw its first four patients, served by three volunteers and one paid employee.  Starting that October, the Clinic, operating in a county owned facility, served the Germantown community two days a week (Tuesday and Thursday) and began to build its patient base and its volunteer base.  That first month the clinic was in operation for nine days and saw 101 patients.  Volunteers worked two three-hour shifts each day from 2 pm to 8 pm.  According to data collected for that first month, these patients were served by eight doctors, ten nurses, and 28 other support staff (technicians, registrars, translators, etc.), all volunteers.  In the nineteen years since those opening days, the clinic has seen thousands of patients served by hundreds of medical providers and support staff.  Today, Mercy Health Clinic continues serving 2,000 patients a year through over 7,200 visits, with a small medical staff supported by 45 volunteer physicians and more than 100  volunteers including nurses, medical assistants, scribes, and translators, and those who provide much needed administrative assistance to patients.

Your support continues to make it possible for so many patients to receive the health care they need to take care of themselves and their families! We are grateful for you!

What does it look like when health care is not accessible?

Health care, and the lack of access to it, has been a prominent topic in the media recently. On Sunday, June 23, The Washington Post profiled a couple in rural Tennessee who, struggling with myriad health conditions, sought assistance at a weekend pop-up clinic staffed by a volunteer medical team. (See “Urgent needs from head to toe: This clinic had two days to fix a lifetime of needs“.)  Another article a few days earlier, “As price of insulin soars, Americans caravan to Canada for lifesaving medicine”, also in The Washington Post, focused on families traveling to Canada to purchase insulin, because it is much less expensive than in the US and available without a prescription.

These articles spoke to all of us at Mercy Health Clinic, as there are many truths in these stories that relate to experience of patients at Mercy. All of our patients are low-income and like the couple featured in the article, most have not had regular access to medical care because they lack insurance and cannot afford care.

Thanks to generous donors, Mercy will serve more than 2,000 patients this year, providing primary care and specialty care for patients who otherwise would have to use the services of the hospital emergency room, which is very expensive and cannot offer the ongoing support to manage chronic conditions, like diabetes or high blood pressure, that Mercy is able to provide.  

Approximately one third of Mercy’s patients are managing a chronic condition, such as diabetes or high blood pressure. If not properly managed, these individuals are at significant risk of hospitalization, re-hospitalization, heart attack, stroke and serious infection that could require amputation of limbs.

At Mercy, medications, including insulin, are provided free of charge to patients to patients so they do not have to choose between buying medicine or groceries, or reduce doses/skip days to stretch their medications until they can afford to refill them.

We are serving the poorest of the poor, including the “working poor” who have jobs but still cannot afford care. More than 70% of our patients live at or below the Federal poverty level, individuals who are caregivers or work in fields that are low-wage and often do not offer health insurance, such as childcare, housekeeping, construction labor and other service positions. Even though they are employed, and work full-time, they still do not have access to health insurance and cannot afford health care. The Affordable Care Act expanded access to care in many states, including Maryland, but there are still some 60,000 adults in Montgomery County who do not qualify for any insurance program. Often, those who do qualify for subsidized “affordable” plans find that they cannot keep up with premiums throughout the year and then return to the ranks of the uninsured. In addition, we are now facing uncertainty regarding local and national healthcare policy and the impact it may have on people struggling with poverty.

Mercy is committed to providing care for our low-income neighbors, and we are continually evaluating how best to meet their evolving needs.

The Ongoing Challenge of Providing Access to Health Care for Everyone

Access to affordable health care continues to be an important conversation both locally and nationally, including here in Montgomery County.

Maryland expanded access to Medicaid for low-income individuals in 2014, and Virginia is just now embarking on plans to expand Medicaid (Virginia’s roll out was the topic of the Kojo Nnamdi Show on NPR which aired on Wednesday, November 14, 2018. You can listen to the show here).

Medicaid is a joint state and federal government program that helps to provide health care for low-income people. Medicaid expansion allows states to set their own standards for who is eligible for coverage.

Montgomery County is a very expensive place to live, with an area median income of $100,352. Annual earnings for someone working full time at minimum wage of $12/hour would be only $24,960. And while more than 95% of our patients are employed, they all remain very low income. Without Mercy, these patients might have to choose between paying for rent, food for the family, or health care and the medications they may need.

Patients whose income is at or below $16,753 may qualify for Medicaid, which does not necessarily mean they have ready access to health care. Many doctors limit the number of Medicaid patients they serve, creating a barrier to access for these patients. To help eliminate this barrier,  Mercy is an available option for Medicaid patients. Mercy also provides primary care and specialty care through the Montgomery Cares program for adults who are not eligible for federal or state health coverage.

Additionally, Maryland residents whose income is above $16,753 but below $48,560 may be eligible to purchase subsidized individual health insurance plans through the Maryland Health Benefit Exchange.

The health insurance environment is complex and constantly changing. Fortunately there are community health resources like Mercy to help our community members who struggle to gain access to healthcare due to barriers associated with poverty.

Mercy continues to work with our community partners to ensure access to health care for low-income patients, including those who do not qualify for Medicaid or subsidies, but cannot afford health insurance.

At Mercy, we believe that we all benefit when everyone in our community has access to health care!

Seeking Smoother Air

So the election happened. I don’t even have to know how you voted to know that you probably woke up on November 9 utterly gob-smacked, one way or another. I won’t tell you my first thought that day, as it’s NSFW. But my second thought was, “uh oh, what’s going to happen to my healthcare?” I know that’s selfish but this is like when you’re on an airplane and they tell you to put your own oxygen mask on first and then assist others. So I put on my mask and tried to breathe normally; the mask would not inflate but oxygen was flowing.

See, I have one of those pesky “pre-existing conditions”. Prior to the Affordable Care Act, I had to get my health insurance through a public plan run by the state, a program that went away once ACA was in place. Having just lost my ACA marketplace health plan (my insurer took its marbles and went home), I’ve enrolled in another plan off-marketplace. I hope it works – I’m giving up every last one of my 20-year doctor relationships to make this move. But at least I can afford it, so there’s that. Mask. Oxygen. Breathing.

That done, my third thought was, “But what about all those other people who depend on ACA healthcare plans and subsidies and Medicaid? Are we about to see a massive surge in the number of uninsured people coming to Mercy Health Clinic for care?” Well, it might not have been quite that well ordered and eloquent of a thought, more of a primal scream; but you get the gist.

Now, normally, a huge swell of new customers is a good thing for a business. But Mercy isn’t a regular business. It’s a nonprofit medical clinic for very poor people who are ineligible for the ACA plans or for Medicaid. As such, we’d rather hoped that there would come a day when everyone could access the health care system without requiring a safety net like Mercy. Most safety-net agencies cheerfully aspire to being put out of business in that way, with the unmet need having been, well, MET. How lofty is such an aspiration — health care is a basic human right, after all, and surely we can agree on that? Call me a pessimist but I’m getting the distinct feeling that we as a nation do not necessarily agree on that. Like I said: gob-smacked.

So what lies ahead when it comes to healthcare in America? The fact is, for right now, we just don’t know. The ACA could stay more or less intact or be completely repealed or something in between. It could receive tweaks, or a sledgehammer. We could simply be in a patch of turbulence, or the plane could be going down. (Hmm. One can stretch an airplane metaphor too far, it turns out. Sorry about that.) It’s safe to say, though, that we’re in a period of great uncertainty, at the very least.

Here’s something to chew on as you either celebrate or mourn the changes that loom ahead. Mercy Health Clinic’s patients live with this same kind uncertainty every day, and they were doing it long before November 9. One aspect of their lives that they know they can count on is Mercy Health Clinic. Mercy has been providing free high-quality medical care, education, pharmaceuticals, and other services to the most vulnerable in Montgomery County for over 15 years. And we’re going to be here for them regardless of what happens out there. If you’re ready to invest in something certain, support the Mercy Health Clinic with your time or your money, or both. Oh, and by the way, the “fasten seat belt” sign is on, and will remain on for the duration of the flight.

— Pam Saussy, Board Member

America the Pink

October is National Breast Cancer Awareness Month. I know — it’s hard to believe that anyone wouldn’t be aware of breast cancer. You’d have to be living under a rock to not know it exists, what with all the walks, marches, bike rides, and pink merchandise to buy to show your support and help raise funds for research. Even the NFL offers special breast cancer awareness “gear”, since nothing puts the kibosh on breast cancer better than a Steelers zip-front hoodie.

Maybe we should call it Breast Cancer Attention Month instead. It seems to me that simple awareness isn’t sufficient. We need full-on attention, and if the pinking of America gets us to pay attention, more power to it. After all, breast cancer is the second most common cancer in American women (skin cancer is first) and the second most deadly cancer in women (lung cancer is first). Scary stuff.

The American Cancer Society estimates that in 2016:

  • Approximately 246,660 new cases of invasive breast cancer will be diagnosed in women.
  • Approximately 61,000 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
  • Approximately 40,450 women will die from breast cancer.[1]

Even one death is one too many. The good news is that death rates from breast cancer have been dropping since about 1989, with larger decreases in women younger than 50. These decreases are believed to be the result of finding breast cancer earlier through screening and increased awareness, as well as better treatments.[2] Regular screening improves the likelihood that cancer will be caught in its early stages, when it is easier and less costly to treat, and with a higher chance of a cure.

My attention to breast cancer is made simpler by being built into my health care – my health insurance plan allows me to have a mammogram every year, so I do. It’s not the most comfortable procedure due to extreme flattening, but it’s quick and non-invasive. Although I might take comfort in the fact that my family history with breast cancer is, to my knowledge, limited to a couple of very aged aunts, 85% of breast cancers are found in women with no family history of the disease.[3] Let’s face it: at the end of the day, no one is immune to breast cancer (not even men). I’m thankful to have access to screening and always relieved to get that “benign – no cancer found” report.

Everyone deserves this peace of mind, including people without health insurance. Mercy Health Clinic works to enable female patients 50 – 75 years old get a mammogram at least every two years, in accordance with standards set by the Primary Care Coalition and HEDIS (Healthcare Effectiveness and Data Information Set). During the most recent quarter for which statistics have been compiled, Mercy is proud that 66% of eligible women patients received this screening, placing the clinic near the top of Montgomery County’s safety net clinics.[4]

As you’re paying attention to breast cancer this month, don’t forget that when October ends and we move on to some other health observance, breast cancer will still be around. If you’d like to help support Mercy’s work to help low-income women stay a step ahead of breast cancer, click here. And then maybe check out that hoodie.

—- Pam Saussy, Board Member

 

[1] American Cancer Society http://bit.ly/2esLHDJ

[2] American Cancer Society http://bit.ly/2esLHDJ

[3] Breastcancer.org http://bit.ly/2epD62v

[4] Q2/2016 performance statistics. www.primarycarecoalition.org

 

Deep Breath In, Exhale

Like many people, I struggle with managing stress in my life. I tried meditating, but I found myself twitching impatiently, waiting for the tinkling chime I’d set on my phone to signal the end of my six minutes of enforced mindfulness. I gave adult coloring books a try, but discovered that I hate coloring. I don’t even like putting eye shadow on in the morning, that’s how much I hate coloring. The irony isn’t lost on me that I’m actually feeling pressured to reduce stress. Maybe it’s just me, but that seems counter-productive.

Nevertheless, my doctors highly recommend reducing stress, and it turns out for good reason. When you experience stress, positive or negative, your brain responds. Your blood pressure rises; your heart rate goes up. Your muscles get tense. Hormones such as adrenaline and cortisol flood your body to put all systems on survival alert. It’s the aptly named “fight or flight” mechanism to prepare your body to act, whether it’s to figure out how to spend all your lottery winnings (positive) or outrun a bear (negative).

We all experience stress simply through coping with the hassles of everyday life: work, kids, traffic, that guy ahead of us at Starbucks trying to order a “small”. While we may be annoyed or anxious for the moment, we typically get over it and all returns to normal pretty fast once we’re out of the situation. Although I’ll admit to holding a grudge about that “small” thing.

Chronic stress, on the other hand, keeps the fight-or-flight reaction going, all the time. For example, people fighting chronic illnesses as well as those who suddenly lose a loved one, live in war zones, or undergo trauma can be less able to dial back the body’s response to stress. Even “normal” everyday-life stress can be so pervasive and without let-up that it can have the same chronic effect.

With chronic stress, there is no clear signal that the threat has been neutralized. The hormones keep flowing; the blood pressure and heart rate don’t ease back to normal. Those under chronic stress might experience digestive problems, headaches, sleeplessness, depression, change in libido, muscle aches or other symptoms. Over the long term, this heightened response can cause or exacerbate serious health problems such as heart disease, diabetes, hypertension, depression, and other conditions.

Poverty can be a major stressor for many people, including those who come to Mercy Health Clinic for help. Economic uncertainty, housing insecurity, poor nutrition, precarious employment, and even noisy living conditions contribute to chronic stress among those living in poverty. The CDC reports that 8.7% of people living below 100% of the federal poverty level (about $24,000 a year for a family of four) experience severe psychological stress, compared to 1.2% of those living at or above 400%. In other words, being poor is stressful and is bad for your health.[1] To that end, depression screening is now a standard component of the performance metrics routinely tracked for Montgomery Cares safety-net clinics by the Primary Care Coalition.[2] Over 97% of active Mercy Health Clinic patients receive depression screening.[3]

Click here to learn more about the causes of stress and ways to reduce the impact of stress on your body. Said body will thank you. And if you decide to give coloring a go, let me know; I have a barely-used coloring book I’d be happy to pass along.

— Pam Saussy, Board Member

[1] http://www.cdc.gov/nchs/data/databriefs/db203.pdf

[2] www.primarycarecoalition.org

[3] For details about Mercy Health Clinic’s patient outcomes, contact Mark Foraker, Executive Director, at mark.foraker@mercyhealthclinic.org.

 

The True Skinny

As a board member for the Mercy Health Clinic, part of my job is to ask people to contribute money or time to support the clinic’s mission of providing top-quality health care to uninsured people in Montgomery County. But hold on. Who says it’s “top-quality”? You could just take my word for it if you know me and trust my judgment. Come to think of it, it would be awesome if you would just do that, and write that check or hit that Donate Now button. Thanks so much.

But if you don’t want to take my word for it, you might want to know how we measure “quality”. We could point you to our Facebook page – we’ve got 4.5 stars! That’s nice, but not that useful when you’re a potential donor or volunteer and want to get the true skinny on whether Mercy delivers the goods.

No, for this job you need data – statistics, in fact, comparing Mercy’s performance against a set of quality metrics agreed upon in advance for the 12 Montgomery Cares safety-net clinics operating in Montgomery County[1]. For the low-income, primarily immigrant population served by the safety-net clinics, several health issues show up more often than others: diabetes, hypertension, and various kinds of cancer. So we measure specific aspects of these conditions, comparing them to nationally endorsed specifications and (and this is important) evidence that improvement in the measure correlates with improved patient outcomes.

So how is Mercy doing? Here are just a few examples from the most recent statistics gathered for Montgomery Cares clinics by the Primary Care Coalition[2].

For diabetes, some key metrics compared across the clinics include:

  • screenings for HGBA1c, which measures blood glucose levels – 92% of Mercy patients with diabetes had a screening within the last year
  • annual retina exams to screen for diabetic retinopathy, a complication that can lead to blindness – 67% of Mercy patients with diabetes had an annual retina exam within the last year (#1 among the clinics!)
  • foot exams to detect loss of protective sensation or ulceration that can lead to amputation and disability – 60% of Mercy patients with diabetes had a foot exam within the last year (#2 among the clinics!)
  • blood pressure control, to stave off complications such as stroke and heart failure – 83% of Mercy patients with diabetes had BP less than 140/90 (#1 among the clinics!)

For hypertension, metrics include:

  • measurement of blood pressure – 100% of Mercy patients with hypertension had their BP measured within the last year
  • hypertension patients with their BP under control – 74% of Mercy patients with hypertension had their BP under control (#1 among the clinics!)

For cancer, metrics include:

  • women aged 50 – 74 had a mammogram to detect breast cancer within the past two years – 69% of Mercy female patients in this age range (2nd among the clinics)
  • women aged 24 – 64 had a PAP smear for cervical cancer within the last 3 years – 58% of Mercy female patients in this age range
  • patients aged 51 – 74 had a colon cancer screening performed within the last year – 54% of Mercy patients in this age range (1st among the clinics!)

Low-income and uninsured people often forego healthcare until their conditions are much farther along and thus more expensive and difficult to treat. Monitoring of chronic conditions such as diabetes and hypertension helps patients keep their disease under control and reduce the likelihood of secondary complications such as vision problems or lower-extremity amputations. Screenings for cancers help identify potentially deadly disease in its early stages when treatments can be more effective.

Another benefit? Cost. Safety-net clinics like Mercy help uninsured patients avoid using costly ER facilities for their primary care, thus helping keep costs down for all of us. Mercy Health Clinic’s model of care relies heavily on volunteers, and provides a diverse multidisciplinary team at our Gaithersburg site. This improves the options for treatment, as patients have access to a primary care physician, nutritionist, and a specialist if they need one. 

These measures are by no means an exhaustive assessment of clinic performance or patient outcomes, and they are a snapshot of performance, which can vary over time. But they do give some idea of what we’re measuring on a regular basis to determine if we’re making a difference in our patients’ lives, and what we mean when we say that Mercy provides top-quality healthcare. I hope you’ll click here to support the Mercy Health Clinic’s mission to make Montgomery County a healthier place for everyone, including those without health insurance. That would be awesome. 

— Pam Saussy, Board Member

[1] Montgomery Cares measures are benchmarked against NCQA’s HEDIS Medicaid performance. NCQA measures healthcare system performance including primary and specialty care. For details about Mercy Health Clinic’s patient outcomes, contact Mark Foraker, Executive Director, at mark.foraker@mercyhealthclinic.org.

[2] www.primarycarecoalition.org

En Garde

When my son was in high school and had just gotten his driver’s license, I’d always throw in a “be careful!” as he went out the door. To my mind, it was a loving, caring thing to say. As a parent of a young person, it’s hard NOT to say it, as the world is full of dangers and the nights full of darkness and terror. (Sorry. Clearly I’ve spent too many hours watching Game of Thrones.) After a few rounds of eye-rolling, he finally pointed out that “be careful” was actually insulting, as if I assumed he was going to do something stupid or careless if I didn’t remind him not to. That was a fair point (and, by the way, absolutely true). He suggested that I use “be safe” instead. Less judge-y, I guess. So “be safe” became my go-to send-off and sign-off to avert potential harm. It’s worked so far, I’m happy to report.

But come to think of it, what does it mean to “be safe”? June is National Safety Month, so it’s a great time to talk about it. When I was a kid, I first learned about “safety” in terms of things. For example, that little bendy paper loop on a sucker was safer than the deadly non-bendy stick. Safety belts protected you in the car (in theory – I grew up in the survival-of-the-fittest 60’s and 70’s when it was still very common for kids to bounce around in back unrestrained).

Later I realized that “safety” is kind of relative. Safety matches could only be struck on some special paper on the side of the box — but could still start a fire. The “safety” in football might be behind the line of scrimmage — but is still going to need to tackle somebody. (Not so safe, at least not compared to being up in the stands with a beer well away from those bruisers in the helmets.) The safety on a gun makes the gun safer to handle, but it’s still, you know, a gun.

Despite the liberties taken with the meaning of safety even for things that, much of the time, are not, safety at its most elemental is the condition of being protected from or unlikely to cause danger, risk, or injury.

Now we’re getting somewhere, and more to the point of National Safety Month. For instance, did you know that preventable injuries are the 4th leading cause of death in the US? That’s behind heart disease, cancer, and chronic lower respiratory disease. Let’s break it down by age group:

  • For infants under 12 months, mechanical suffocation from pillows, stuffed animals, or improper sleeping position causes more than 2 preventable deaths each day;
  • For ages 1 to 24, car crashes result in 21 preventable deaths per day (and are the #1 cause of teen death);
  • For ages 25 to 64, poisoning, mostly from misuse of prescription drugs, causes more than 92 preventable deaths per day;
  • For ages 65 and older, falls result in more than 69 preventable deaths each day. [1]

Each day. That adds up. Unintentional injuries account for 31 million emergency-room visits annually and over 130,000 deaths.[2]

As bad as those statistics sound, don’t forget that magic word: preventable. We can all live more safely by learning about common risks and taking a few precautions. For instance, babies should sleep in a crib, not their parents’ bed, and without pillows, blankets, and stuffed animals. On the road, passengers and drivers should wear seat belts every time. Parents should give their teen drivers extra practice even after they get their license. All of us (even if we’re over 24) should hang up and drive; research indicates that even hands-free phone use is unacceptably distracting and dangerous no matter your level of driving experience.[3] Talk with your doctor about how to use prescription drugs, particularly opioids, sparingly and safely, and never share your prescription drugs with friends and family. Do a safety audit around your home if you’re older or otherwise at risk for falls, and use non-skid mats and grab bars as well as adequate lighting to make it safer to get around.

See? Nothing too painful or difficult about any of this. Learn more about how to be safe at home, work, and play by visiting www.nsc.org. And while you’re at it, put down that sucker; it’ll rot your teeth.

— Pam Saussy, Board Member

[1] National Safety Council, http://bit.ly/1tyTZ0C

[2] Centers for Disease Control, http://1.usa.gov/1tySKPc

[3] National Safety Council, http://bit.ly/1tyR8oD

Unblock Me

I’m sitting here trying to think up something new to write for this month’s Mercy Health Clinic blog, and I’m just blocked. There are plenty of “health observances” this month – stroke, mental health, skin cancer, and many others that I could write about, but I’m just not feeling it. In fact, I’m so blocked that I’m finding myself drifting to thoughts of… fundraising. Now, writers will do almost anything to avoid writing, but usually mundane stuff like alphabetizing their DVD collection or wrapping pennies or building bookshelves (read The World According to Garp if you don’t get that last one). You know the universe must be taking a dire turn when the prospect of fundraising is more appealing than writing.

But it’s not just any fundraising, you see. As chair of the Mercy Health Clinic’s board development committee, I’m supposed to help figure out some strategies to assist our valiant development staff raise the funds needed to operate the Clinic. This isn’t someone’s trip to music camp or a new dating app we’re crowdfunding. It’s about operating a medical clinic for very poor people who can’t get health insurance — about 1600 patients annually, for about 6,000 visits to deal with everything from common colds to heart disease and diabetes.

For example, Lela*, 54, came to the US 28 years ago from Ethiopia and raised three children here. Recently she went to a local hospital complaining of weight loss, severe thirst, and frequent urination. Lela was diagnosed with high blood sugar and Type II diabetes. Because she was uninsured and her income while working was only $16,000 a year, she qualified for treatment at Mercy Health Clinic. While at the Clinic, Lela met with a nutritionist and a retina specialist; she also received insulin to treat her diabetes. Lela received these services and insulin at no charge.

That’s right. Mercy Health Clinic is a free clinic – for patients. But that doesn’t mean it’s outright free, period. Stuff still costs money. Mercy gets many things donated by wonderful partners: lab tests, radiology services, surgical procedures, pharmaceuticals, and of course direct medical care itself from an impressive cadre of volunteer doctors and nurses. The value of these in-kind contributions adds up to about $1.5M annually, and that’s amazing. We couldn’t help people like Lela without that support.

But rent, equipment, insurance (including malpractice insurance for medical volunteers), medical and pharmacy supplies, utilities, a small paid staff, and many other routine operational needs are not covered by in-kind contributions. These expenses must be met out of Clinic’s cash revenues, which include patient reimbursements from Montgomery County, foundation and government grants, and donations from individuals, workplace campaigns, and civic and faith groups.

The Mercy Health Clinic is a true community-based clinic, serving people who live and work in our own county. Honestly, if we were any more grassroots, we’d need mowing twice a month. As such, though, we don’t have the fundraising apparatus available to Big Disease. (I just made up that term but you know who I mean.) Instead, we on the board and the development staff ask generous people to donate money, either directly by sending a check or donating on the website, or by supporting our annual Gala and Golf Classic. Watch for additional opportunities this year to learn about Mercy Health Clinic and how you can help. We hope you’ll give because you feel as we do, that everyone deserves high-quality medical care without regard to their ability to pay — and it’s our responsibility as decent humans to do what we can to make that happen.

Well, look at that. I figured out what to write about after all.

Not her real name.

—- Pam Saussy, Board Member

 

To Halve and Halve Not

So you live in Montgomery County, Maryland. Congratulations! You live in one of the wealthiest counties in the entire United States, with a median household income of about $95,000 a year. Pretty sweet!

Don’t pop those champagne corks just yet, my friends. There’s the matter of that beige little word “median” in there. No, it doesn’t mean “average”, although that would be awesome in this case. It’s the mid-point, which for our purposes means half of county residents fall below that $95K income and half above it. Still pretty good, right?

Well, maybe. Consider this: according to the 2012 Self-Sufficiency Standard[1], a family of three (one adult, one pre-school child, and one school-age child) would need an income of $77,933 per year to be able to live here without financial assistance. We’re not talking living the high life — just the bare minimum for rent, food, transportation, medical care, and other essentials.

Let’s say our family’s adult works in a service job where he or she earns the minimum wage. In Montgomery County that means $9.55 an hour, not too shabby or at least not as shabby as it is lots of other places. That person would have to work 8,160 hours in a year at such a wage to hit that self-sufficiency income level. Uh oh. That’s about 157 hours a week, leaving a whopping 11 hours for a person to eat, sleep, take care of those two adorable kids, and deal with everything else other than work. In other words, impossible, at least here on the planet with the yellow sun where days are only 24 hours long. Sorry to force math and physics on you but it is the only way.

There’s more. You’ve probably seen references to the “Federal Poverty Level” and wondered just what that’s all about, so here goes. It’s a complicated calculation made by the federal government to establish just what we mean when we say someone is “living in poverty” in this country. It’s too complicated for me to explain, actually, so go look it up yourself at http://1.usa.gov/1Muesv. Anyway, for 2016, the Federal Level of Poverty for our little family of three is $20,160.

That $20,160 is only about 26% of that Self-Sufficiency Standard level of income needed to just get by in MoCo. Think about the sheer impossibility of living on $20,160 or less, in a county where more than half of the residents make more than $95,000 a year. Market costs for housing, food, clothing, childcare – everything – tend to be aligned with that top half. Being poor in such an expensive place means making daily trade-offs: pay this bill or that one, but not both. Buy food or medicine, but not both. And the stakes are so much higher when you live in poverty. You get too sick or for too long, or your car dies and you can’t afford to fix it to get to work, and you might lose your job. You lose your job, and you could easily lose your home. Hard to believe, but here in Montgomery County, one of the wealthiest places in America, nearly 70,000 people may be one illness or job loss away from financial catastrophe for their family.

At the Mercy Health Clinic, the majority of our patients are living at or below 100% of the Federal Poverty Level like our imaginary little family (except ours are real). For some of these patients, their income is so low that even a subsidy isn’t enough to help them buy health insurance through the health exchange; others lack the documentation to do so. That’s why Mercy exists, to provide free, top-quality health care, prescription medications, medical oversight, and health education to these most vulnerable of our neighbors.

To learn more about poverty in one of the wealthiest counties in America, click here http://bit.ly/23vi2NX. Then come back and click here to support the Mercy Health Clinic. I promise you’ll feel better even after all this math.

— Pam Saussy, Board Member

 

[1] Healthy Montgomery; http://bit.ly/23vikEy