It is a slow day...

It is a slow day at the clinic. I am the only one here this afternoon. It is cold, I’m sleepy, and wondering what I am doing here.

Then the phone rings. It is a gentleman asking questions about Michigan Medicaid. He knows he will qualify – his only income is from picking up odd and end jobs while he is the sole caregiver for his 91-year-old mother. We talk for about 15 minutes. It is clear he is lonely, and doesn’t have anyone to talk to very often. So, he talks to me. About his mother, about his life – his vegetable garden, what he gave up to come take care of his mother, and his healthcare options.

I didn’t do anything to help him; he just needed someone to talk to. Is that the reason I am still here this afternoon? Maybe.

It is almost March 31st

The March 31^st deadline looms. Connie and I have helped a few dozen people with the application process for healthcare. We have seen a bit of everything – those who qualify for great insurance at an affordable price; those who leave in tears because even this insurance is not “affordable” in their reality; those whose identity can’t be verified because they have never taken out a loan or had a credit card; those who qualify for a good subsidy, but because they smoke, it doesn’t cover the cost of the premium for healthcare. Literally, a little bit of everything.

There are those who believe all the negativity and have decided that they do not want health insurance, including one young woman who is going to be facing surgery to remove her gallbladder. She won’t even talk to me about health insurance. I wonder how the surgeon and the hospital are going to feel about that… she would qualify for subsidies to help pay for her insurance; she and her husband both have low-paying jobs. It is possible that the hospital and the surgeon are going to expect payment, maybe even garnishee their wages. I don’t know what will happen, but it is certainly possible now that she could get insurance.

So, as I look at the calendar and see March 31 is a few days away, I think about our experience here. We have seen very few individuals… partly because we didn’t become a Certified Application Counselor Designated Organization until almost December (even though we applied in August). We were a couple of months behind when we started. The healthcare.gov website had more than its fair share of problems. And, many of the patients we see here at the clinic will qualify for Michigan Medicaid once that program is open… which, disappointingly, will NOT be until after the first of April.

One of my frustrations is that Medicaid won’t open until after the deadline to apply for healthcare in the Marketplace. I think there is a process we can use if people thought they would qualify for Medicaid and don’t, but I am not sure how that will work.

We have spread the word via the newspaper and radio station that we are assisting with applications, so we get a few calls that way. Most of the people we have seen are former or current patients of the clinic.

Six months seemed like a long time for an open enrollment, but it hasn’t felt like much time at all. We have had so much to learn and so much to teach. People have been reticent to enroll, partly because of all the negativity.

I hope that the Medicaid enrollment will be smoother. I hope we are successful in helping people enroll in the program – and have real access to healthcare.

In the meantime, we are still here, still helping people with access to the necessary healthcare services and medication.

 

Full Moon

So, last week's clinic was on the Tuesday after a full moon on Sunday. I know, there are those of you out there that are thinking – OK, she’s nuts. But, seriously. You should be in a hospital, an Emergency Room, or a free clinic during the full moon phase. It is not something we make up.

 

Tuesday night, a man came in well after our 6 p.m. cut-off wanting to be seen. He was told that we don’t see anyone that has not registered by 6 p.m. … but he proceeded to tell me that he has come in “all the time” after 6 p.m. and is always seen (lesson number 1: don’t lie to me – I can put up with a lot, but not lying). He was also visibly drunk. He left, then came back requesting a note for his employer that he had been at the clinic. After escorting him out the door, I was dealing with the next crisis – a loud, brash, rude woman complaining about how long it was taking to get seen – by a chiropractor at a free clinic!?! Seriously? Yup, she was complaining. She went as far as to say one of the volunteers didn’t like her, so she put her chart to the end of the line (lesson number 2: don’t be rude to my volunteers).

As I am listening to her complain (not really the word that was going through my mind), Connie brought me the phone. It was the wife of the drunk man – accusing us of all sorts of things. We had told her we would see him (not true – again, don’t lie to me) and that he was not drunk (really? I am not stupid) and that she wanted to speak to my supervisor. OK – not a problem, except, oh, yeah – I am the supervisor. Sorry. (And, I will admit, I hung up on her – there is no reasoning with idiots, and there were other issues to deal with).

One of our long-time patients was in – he said to me, “remember when I was here the last time? I had that tooth ache?” Well, I did remember because he didn’t stay, so he wasn’t seen by the doctor. So, he then tells me, “I left here that night and went to Walgreen's and got one of those gels for toothaches. I used that and then I pulled my own tooth. Got rid of that.”

Oh, no… can you imagine? Pulling your own tooth? And, what if it broke, and what if there was an infection and what if???? Oh, my.

Susan was here for a follow-up on her tests. We were able to order the next test that needs to be done for diagnostic purposes. I talked to the doctor that saw her – it sounds like there is hope for a favorable outcome, but we have to know for sure what is going on. Scary stuff.

One patient was here for medication refills and began having an allergic reaction. Not sure to what – she had eaten just prior to coming here, but had no previous history of food allergies. She started off itching, with some swelling. We got her right in to see the doctor, and fortunately were able to give her an injection of steroid and then put her on a steroid medication to continue treating the allergic reaction. Scary stuff.

There were the rude, the impatient, and the grateful. Sometimes on these crazy nights all we hear is the craziness. But, at the end of the night there are the people we have helped, those who come in quietly, are polite and patient, and those are the ones that matter. 

But, somehow, we remember the crazy, rude, drunk ones. It is always a challenge for me to look into those eyes and see the face of God. But, that is what I am called to do – and I keep on trying.

Susan

Susan came in to meet with me to sign up for insurance. She had been identified during our screening process as someone who would not qualify for the Medicaid expansion, and needed to look at her options.

Susan has two part-time jobs, working for two local physicians. She was sent here because of headaches accompanied by nausea, vomiting and blurred vision. Her blood pressure was elevated at the clinic, but she had no history of high blood pressure.

She was sent for a CT Scan of her head. The CT showed a sinus cyst, so a referral was made to an ENT (ear, nose and throat doctor).

The headaches and nausea continued, so the decision was made to have an MRI and also a Magnetic Resonance Angiography (MRA), which is a group of techniques used to image blood vessels. MRA is used to generate images of arteries in order to evaluate them for stenosis (abnormal narrowing), occlusions, aneurysms  (vessel wall dilatations, at risk of rupture) or other abnormalities.

The MRI came back normal; but the MRA showed a “tiny outpouching… which may represent an aneurysm…”

Needless to say, she was devastated when she came in to see me. One of the physicians she works for had given her the results; the next test that needs to be done is not available locally, and the clinic has no ability to access the necessary testing for her.

The need for insurance was no longer a luxury, but a necessity.

So, we began the process. But as she answers the questions and we fill out the online form, it becomes clear to me that she will qualify for the Medicaid expansion – whenever it is finally available in Michigan. Red-tape, dumb legislators, and a system wrought with problems are keeping the expansion of Medicaid in Michigan from becoming a reality.

We talk about her options – she does qualify for tax subsidies because of her low income; but there are still some very real costs involved with insurance – deductibles, co-pays, out-of-pocket expenses. She looks at her reality: she needs access to healthcare NOW – not at some unknown point in the future. So, she makes the decision to purchase healthcare.

Please, please, please remember this: under the old healthcare system, she would not have been able to purchase healthcare for a number of reasons – cost being a major one. But, with a pre-existing condition such as this possible aneurysm, she would not have been able to purchase healthcare insurance. IF she had been able to purchase it at all – it would NOT have covered this condition – it would have been excluded because of being pre-existing.

The wicked, awful thing called “Obamacare” by many will possibly be what saves this young woman’s life. Did I mention she is 29 years old? She could be our daughter. She could be the daughter of any of us.

How can anyone believe that she doesn’t deserve access to healthcare? I don’t understand how mean spirited our country has become.

She will be able to purchase healthcare for a monthly premium of $0; she will have a deductible of $175 and will have co-pays to doctors and for medications. But, she will have real access to real healthcare.

She may still qualify for Medicaid at some point; but, for now she has healthcare beginning April 1 – and hopefully, that will be soon enough!

As it turns out, she shouldn’t have been referred to me. The clinic looks at household income for qualifying people for services; the government looks at who files taxes. So in this case, even though she lives in a household with more than one wage earner, she files income taxes on her own, so she qualifies for subsidies based on her income. I am glad a mistake was made in this case.

It might save her life.

The Latest on Paul

Paul was back in the clinic last week. He needed his insulin and a refill on his medications. We had talked to him a couple of times – he was finally discharged from the hospital, only to come home to frozen, burst pipes. That is not an uncommon problem in this climate when the temperatures are so low and a home is inadequately heated.

He had some family that was able to help him with the necessary repairs so that he could have running water.

He is getting all of his nourishment from his feeding tube; that makes regulating his blood sugar pretty complicated. All things considered, when he came in last week, he didn’t look too bad.

But, that belies the situation. He has a diagnosis of esophageal cancer (one of the most deadly) with metastasis to the liver. His prognosis is not good.

And, because he is uninsured, getting the treatment he needs is very difficult. He has very few resources; he is alone – the family he has lives on the other side of the state; and transportation is a problem as it is for many living in isolated rural areas such as ours.

I don’t know what is going to happen to Paul. He will have Medicaid soon and will be able to access some treatment. Probably, it will not change the outcome at this point.

The 16 Sweetest Reasons to Get Covered:

Women can't be charged more than men … Because accidents happen… Preventive care is free… Insurance companies can't discriminate … No lifetime limits on coverage... Insurance companies are accountable to you… It will give your mom peace of mind … Injuries can lead to huge medical bills... Checkups could save your life … You only live once… You might qualify for free or low-cost coverage... Health care should be a right, not a privilege … You never know when you'll take a hard foul... It's the smart thing to do... Nobody's invincible… Being uninsured is scary

Update on Len

The report is sitting on my desk when I arrive this morning. It is from the Cancer Center: it is official, Len has cancer. He has metastatic cancer with unknown primary site – Stage IV.

The cancer has been found in his iliac wing (his hip bone) as well as in his spine.

For most types of cancer there are four stages, with Stage 1 being an early cancer and Stage 4 an advanced cancer; with cancer of unknown primary, the doctor doesn't know where the original cancer started.

None of this is good news.

When the primary site is unknown, treatment is difficult to plan. None of the tests done to date point to a primary site. The plan at this point is to treat the cancer with radiation therapy – not in an effort to cure it, but to lessen the pain. Testing will continue… when he qualifies for Medicaid. In the meantime, he has started treatment.