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

An article in the Sunday, June 23 edition of The Washington Post entitled  “Urgent needs from head to toe: This clinic had two days to fix a lifetime of needs” spoke to all of us at Mercy Health Clinic. The piece profiled a couple who decided to seek care at a pop-up weekend clinic staffed by volunteer medical personnel for their first medical appointment in four years. When Lisa’s  appointment reveals that she has an urgent medical condition, she is transported to an emergency room for care, then released with an estimated $3,000 debt that they wouldn’t be able to pay, meaning more uncollected debt for a small rural hospital that struggles to stay in business.

There are many truths to this story that relate to patients at Mercy. Thanks to generous donors, Mercy will serve more than 2,000 patients this year. All are low-income and many have nowhere else to go for medical care other than a hospital emergency room, which is the most expensive level of care and the one that cannot offer continuity of care, which is especially important for those managing chronic conditions like diabetes or high blood pressure.

In The Washington Post a few days before, another article, “As price of insulin soars, Americans caravan to Canada for lifesaving medicine” had focused on families who, outraged by the rising cost of insulin, who were able to buy the insulin they needed in Canada, without a prescription, for a fraction of the price they would pay in the US.   

At Mercy, medications, including insulin, are provided free of charge to patients because we know that the cost of medication may be a barrier to treatment. Patients might have to choose between buying medicine or groceries. Additionally, patients have been known to reduce doses or skip days to stretch their medications until they can afford to refill them. At best, these choices reduce the effectiveness of treatment, and at worst, could have a serious or life-threatening consequences.

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.

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!