Free Clinic takes care of uninsured
By Cynthia T. Pegram
Lynchburg News and Advance
Wednesday, May 12, 2004Irving Irizarry doesn’t have health insurance but has been through some major health problems. His care comes through the Free Clinic of Central Virginia.
“To tell you the truth, I wouldn’t have known what to do without the Free Clinic,” he said.
Irizarry is among the estimated 23,500 people in Central Virginia who don’t have health insurance. Nationwide, that number tops 44 million.
According to state-by-state data released by the Robert Wood Johnson Foundation for Cover the Uninsured Week, some 14.2 percent of Virginia adults between the ages of 18 and 64 don’t have health insurance - about 664,409 people.
In Virginia, nearly half of the uninsured have at least one child in the home. About 11 percent of all working adults are not insured. And of those, 23.8 percent say they’ve not been able to get medical care in the past 12 months.
The Free Clinic of Central Virginia on Main Street in Lynchburg serves the uninsured. The patient population - about 70 percent of whom are working - falls into three or four groups, said Bob Barlow, Free Clinic executive director.
They include 55- to 65-year-olds who aren’t eligible yet for Medicare, but who are underemployed or aren’t employed because they’ve been laid off.
“We have another group from 18 to 25,” Barlow said. “Those are students who end up taking jobs that don’t have benefits. They get out of school, maybe marry young. They might have a job, but that job may not have benefits.”
A third category is people who are disabled but who aren’t yet on Medicaid, and “who really don’t have any place to turn, other than Free Clinics,” Barlow said.
The fourth group includes the people working two jobs, 20 to 25 hours a week at each one, but neither has benefits.
“There’s a lot more companies, industries, offering part-time positions because benefits have become so expensive,” said Barlow. “If they can hire two people at 25 hours a week, they end up doing better than hiring one person at 40 hours a week.”
Yet, the most common misperceptions are “that most uninsured people aren’t trying to work or aren’t working - that they’re just sort of ‘out-there people’ who aren’t doing anything to help themselves,” said Barlow. “That’s really not the case.”
Most have fallen victim to some kind of circumstance with an employer, the economy or society, said Barlow. “They end up being captured by that situation and can’t get out of it.”
Irizarry first went to the Free Clinic because it was required by Gateway, a New Land Samaritan Inns residential program for men.
Now 49, he has been a Free Clinic patient about 3½ years. At first his health was very bad - a spinal cyst put him in a nursing home for a time. Now with damaged spinal nerves, his disabilities include impaired use of his legs.
A diabetic, he gets his medication from the Free Clinic for a few dollars per prescription.
“It is fantastic,” he said. He’s in the spend-down process and expects to be covered by Medicaid at some point in the future.
“I wish I could work. I wouldn’t have to be going through all of this mess,” he said.
“That’s why people should be grateful for the Free Clinic,” he said. “Especially for the old folks who are not insured, especially the medication.”
“If it wasn’t for the Free Clinic, I tell you the truth, I would be 6 feet under. How would I be getting my medication? I don’t know. How would I pay my (medical) bills?
“They’ve been so caring - very professional in what they do. The whole crew works together. The way they tend people, it is like their own family.”
Although he can’t pay for care, a now much healthier Irizarry volunteers at the Free Clinic. And because Irizarry speaks both English and Spanish, said Barlow, he has acted as translator for patients who speak only Spanish.
The numbers of people who are not insured seems to be increasing. Centra Health’s billings show that “self-pay” as a category has increased from 7 percent in 2002 to 8 percent in 2003. Centra Health owns Lynchburg General and Virginia Baptist hospitals.
Low-income patients without insurance have some institutional options for care.
Some services on a sliding scale fee can be obtained from the Lynchburg Health Department and at health departments in Amherst, Appomattox, Bedford and Campbell counties.
The Emergency Department at Lynchburg General Hospital can’t turn anyone away because they can’t pay. Services from the Johnson Health Center on Federal Street, a federally certified community health center, are available on an income-based scale.
About 12 percent of the Johnson Health Center patients are either uninsured or qualified for federal guidelines for reduced payment, based on income, said John Sniezek, director of the Johnson Health Center.
Over the last few months, the Johnson Health Center has expanded its hours and started a walk-in service.
“There are so many people looking for services and who need to establish with a practice,” said Sniezek.
The clinic has seen an increase in all patient categories - from 35 to 45 patients a day to 85 to 110 a day, said Sniezek. Johnson Health Center accepts people who are covered by Medicare (insurance for people 65 and older and some disabled) and Medicaid (coverage for people with low income) as well as private insurance.
Only 6 percent of the Johnson Health Center patients have private insurance of any kind.
According to Joe Payne, director of community health and wellness for Centra Health and board member of the Johnson Health Center, the hope is that the extended hours will give people a medical home.
The center can give better primary care for coughs and colds than the Emergency Department “which is not the appropriate level of care for that kind of medical problem,” he said.
With Saturday hours planned as well, that can increase patient care, said Payne.
Sniezek says that people need to be aware of the significant number of Americans who have no health insurance.
“We have people that have a variety of health care issues … needs that are not being met,” he said. Many have serious health conditions that become chronic illnesses such as diabetes, asthma and diseases of the circulatory system.
Failure to provide insurance coverage to the uninsured, he said, is penny-wise and pound-foolish.
“It is more expensive to treat those conditions later in life, than if we had a preventive, proactive, approach to health care,” he said.
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