Medicaid Matters

As the Executive Director of a free clinic in rural southern Michigan, I see patients every week that would benefit from the Medicaid expansion. We see individuals who are working - but have no healthcare; those looking for work; and those who have given up the search for work.

We see individuals with disabilities who have no healthcare, because they "make too much" to qualify for Medicaid. When I first learned that people receiving disability income did not have healthcare, I was appalled. How can it be that we deny healthcare to those in the most need?

It is not uncommon for our patients to hold two or three jobs, but have no healthcare. Many places of employment will only hire part-time help, in order to avoid having to provide benefits, including healthcare.

We all benefit from increased coverage for healthcare.  Healthier individuals make for a healthier society.  We are able to help people stay employed when we provide medications necessary to control chronic health conditions.

On a typical Tuesday evening at St. Peter’s Free Clinic, the following patients may be seen. Sue, who has a cough and fever, is worried about losing her job if she calls in sick, and she has no health insurance. Lynn is a 50 year old widow, who has been having heart problems since before her husband died, and now has no health insurance. And, Jim, who due to multiple health problems, has recently lost his job and along with it his health insurance, and has no idea where to go for help. While he was at the Clinic he not only received health care and medications, but was given a list of community resources to help him access other needed services and a small box of food to feed him that night.

But we are only here one night a week. With Medicaid, these people will have access to healthcare WHEN they need it, not when we are here. No one should have to put off getting the healthcare they need for a week because the clinic is only open once a week.

According to a report from the Institute of Medicine, uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner. About 18,000 unnecessary deaths occur each year because of lack of health insurance.

We see it too often. Now is the time to act, and prevent some of these unnecessary deaths.

Cute Shoes!

Theresa comes in wearing the cutest shoes – that’s why I notice her tonight. It is an unusual sight here at the clinic – someone well dressed.

She tells me that is why she’s here – her feet hurt! Oh, my. And you are wearing those shoes? She laughs, but she likes her cute shoes.

It is interesting what you notice. I didn’t see the depression and anxiety. But she has been a patient here for six or seven years – mostly dealing with depression, anxiety and asthma. That is a pretty common list of diagnoses for someone coming to the clinic.

She is married with three children. Her husband works full-time, as does she. Neither of their jobs provides healthcare insurance. The children are covered by the Michigan Medicaid program for children, so they have full coverage – healthcare and dental.

The clinic is able to provide her with the medications she needs to control her asthma. She gets medication for the depression and anxiety – but, is a pill really enough? I always worry that we are unable to do enough – a pill won’t fix the problems… just help deal with the day to day.

And, her foot pain, what is that about? She was able to see the podiatrist here and have x-rays done. The x-rays were “normal for a patient of this age.” The podiatrist diagnosed her with “foot pain due to pinched nerve.” He recommended she wear a “good shoe.”

She was here in snow boots the last time I saw her, which is a good choice in this climate! She told me her feet hurt no matter what shoes she wears, so she wears her cute shoes when she wants to, and “sensible shoes” the rest of the time.

Maybe by this time next year, she will have healthcare insurance. Until then, we will help her to deal with the asthma and the depression. And, admire her cute shoes.

Heroes, Part 2

I am going to have to stop telling women that I love their husbands! But, that it the first thing I said to Mary when I met her.

Fortunately, her response was, “He is really great, isn’t he!”

Her husband is Tim, and he volunteers here at the clinic. Tim is a pharmacist who came on board to help Keith and Marilyn. Tim didn’t really love working here – and because he was in a high stress job, it was difficult for him to be here on Tuesday nights.

Then the opportunity opened up for a pharmacist to become part of the team for our Diabetic Clinic. I was able to talk Tim into doing that job – and six years into it, he is still our Diabetic Clinic pharmacist. He is amazing to work with – bright, caring, and knowledgeable.

Have I mentioned that I love my pharmacists?

When the clinic first opened, I had no idea that I would need pharmacists. I had never worked in an environment where pharmacists were a part of the team.

I would never again work where they are NOT part of the team. What the pharmacist brings to the table is amazing, and vital to the care of our patients.

Tim is helping us out on Tuesday nights now while Keith is going through his treatments. We could not function without the help he gives us.

He is another one of my heroes.

Update

An update on my patient with Malignant Melanoma: he now has insurance! That’s the good news – the social workers at the university hospital facilitated getting him qualified for Medicaid/Medicare due to disability. The bad news… he’s waiting on biopsy reports to tell him how far the cancer has spread.

So, we couldn’t really celebrate last night. Yes, there was some good news. But it is too little, too late.

Heroes, Part 1

I find that I have many heroes in my life. Some are my personal heroes, for personal reasons. The ones I am going to write about here are the heroes that have been part of my journey through the years here at the clinic.

Keith Lewis is one of my heroes.

I had never met Keith before he was roped into volunteering at the clinic. Keith is a pharmacist, and when I met him, he worked in a local retail pharmacy. He agreed to come in and organize the medications for the clinic. At the time, we were working with sample medications. We had so many medications, and absolutely no idea what some of them were and whether or not we would need them.

We were using a little tiny closet in the hallway as our dispensary at the time. It was a disaster. So, Keith came in after hours and organized it. He told me he would only organize it, that he did not have time to do anything other than that.

Ten years later – he is still here. Clearly, it was not possible to organize me!

Keith and his wife, Marilyn – who is also a pharmacist, worked the clinic every single Tuesday night for the first several years. They were finally able to find some other pharmacists to fill in when they were on vacation, and ultimately, to work every other week.

Keith is my rock – he is one of the smartest people I know, and he is the one I turn to with questions about the clinic. He was worked with me to develop a formulary that provides for our patients; he works closely with our physicians and providers to ensure that patients are appropriately treated; and he now serves on the board.

Last September, late on a Tuesday evening when Keith and Marilyn weren’t working, they came in the kitchen door. We were all pleased to have them drop by to see us – that is, until they dropped a bombshell on us.

Keith had been diagnosed with Stage IV metastatic prostate cancer. It had metastasized to his bones. Keith had always had annual physicals and blood work, so this was truly a shock.

Shock doesn’t really describe the reaction we had and continue to have. Devastated, sad, scared… well, any of you who have been given this type of news know how awful it is.

He describes his disease as “not curable, but treatable.” His first course of action was to get on as many prayer lists as he could.

And he started treatment. I won’t detail all of that because it is his story.

This is my story – he is amazing. As he has gone through treatment, he has continued to volunteer at the clinic. He encourages all of us as he manages his disease. He is currently on experimental treatment, with some wicked side effects, but he feels that it is what he is to do – for the future of cancer treatment and for how it may help others.

Keith is one of my heroes, and I probably haven’t told him that. But now you all know it.

Keep him in your prayers, please.

Liz and Jack

It is not unusual for couples to both be patients at the clinic. Typically, if one is uninsured, they both are. So, Liz and Jack are a fairly typical couple. They both have chronic healthcare issues. They are both employed – he works a job that tends to be seasonal, so makes decent money when he works, but cannot count on work all year. She works as a housekeeper at an extended care facility. They give her 37 hours of work per week, and that way they don’t have to provide her with benefits: namely, healthcare insurance. It is how many companies keep their costs lowered.

They both are compliant patients – they get their medications regularly, see the doctor when needed and follow our directions, as best they can.

She needs insulin – a very costly medication. The clinic cannot afford to purchase insulin, so we access it for our patients through the Prescription Assistance Programs offered by pharmaceutical companies. These medications are provided at no charge to the clinic or the patient; the patient has to qualify – usually based on income and insurance status. Liz and Jack make too much for her to qualify for the insulin. They don’t make enough to purchase affordable healthcare coverage; they cannot afford her insulin.

So, what do you do? Liz’s health will decline rapidly without the insulin. When her health declines, she will no longer be able to work; she will eventually have to go on dialysis or have a kidney transplant.

How does any of this make sense? If we could get the insulin she needs, we could prevent the complications of her diabetes from becoming this severe. We could ensure that she would be able to continue working, continue contributing to society, but instead… she could very well end up on disability.

How does this make sense?

Happy New Year!

The clinic closes for two weeks over the holidays each year. It gives the staff and volunteers a time to enjoy the holidays with their families, and gives everyone a much needed break.

But for our patients, it means no access to healthcare for over two weeks. We provide them with the medications they need to manage their chronic healthcare issues, but if anything acute occurs – where do they go? How do they access care?

This year over the two weeks we were closed, at least three of our patients were admitted to the hospital. I don’t know if any of the admissions were avoidable had we been here, but I have to wonder about it.

2013 – one year until the main components of the Affordable Care Act (Obamacare) take effect. And there are so many unknowns. I wonder as this year begins what next January will look like. What will the role of the clinic be as the ACA goes into effect? There is so much to learn, so much to absorb. I am so excited to think that my patients may have access to REAL healthcare in another year. I am also worried about how they will access that care; how they will get enrolled in the appropriate plans; and how they will afford healthcare. Will there be enough providers to take on the newly insured?

I think that this year will be an interesting journey – for me and for others as we try to figure out what the questions are and how to get the answers we need.

I am pretty sure that access to quality healthcare for all Americans is still a dream that will not be realized just yet. But I think this is an important step in that direction. I am really excited to be part of this process.

Happy New Year!