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By Rose Hoban
Across North Carolina, more than 1.1 million working-age people lack health insurance and access to care. And across North Carolina, there’s a patchwork of community health clinics, rural health clinics and free clinics that provide a safety net for those folks.
Many of the folks served by those clinics are rural people, the kind of voters who gave Republicans big electoral margins in last November’s elections.
“Two-thirds of our membership is rural,” said Randy Jordan, CEO of the North Carolina Association of Free and Charitable Clinics.
Jordan and his colleagues came to the legislature this week to remind lawmakers about their patients, and to ask for help.
According to statistics compiled by Jordan’s organization, free and charitable clinics saw more than 78,000 patients in 2015 for about 171,000 visits.
“We have 75 service sites, represented by 68 members,” he said. “There are some that are open one day a month, and some open five days a week. In my experience, it’s somewhere between two or three days a week would be the average.”
Return on investment
Marie Dockery and Nancy Litton sat on a couch outside the office of their new state senator, Paul Newton (R-Mt. Pleasant), waiting to tell him about their Concord-based Community Free Clinic.
“Our biggest needs now are increased capacity with flat funding,” Dockery said. “Other sources of historical, traditional funding are being diminished and disappearing.”
“No matter how hard we work in the local setting with our supporters and our collaborative partners and corporate leaders, there’s not enough time to catch up with what we’re losing.”
About a thousand unique patients came to Community Free Clinic last year, Dockery said. About two-thirds of them were seen at the clinic, the rest were sent to Carolinas HealthCare System Northeast medical practices that become their medical home.
“They’ll agree to see a limited number [of patients].”
The clinic, CHS and Cabarrus County’s public health agency, Cabarrus Health Alliance, work together to find specialists for patients in need of specialty care and spreads the unreimbursable work around.
Dockery said many, if not most, of their patients have chronic problems, such as diabetes, obesity or high blood pressure.
But because they’re able to manage those patients’ care, it reduces costs for everyone. Dockery knows – her accountant and auditor helped them calculate the numbers.
“For every one dollar invested in our community free clinic, we return 18 dollars in health care services back to Cabarrus county,” she said.
The others had a similar message about their return on investment; Jordan said his organization estimates that their members, on the whole, provide about $7.95 in services for every dollar spent.
The folks from home
So, the clinic leaders think they’ve got a case in asking the legislature for an additional $7.5 million in state appropriations this year to support the safety net clinics. That would be on top of making the $6 million in one-time money allocated in last year’s budget into a recurring funding stream.
“There’s uninsured and underinsured residents, family members, neighbors and friends that need access to health care,” Dockery said.
Aside from the financial and the practical arguments, the clinic heads also have the strength of personal ties to help nudge lawmakers in their direction.
Four of Kim Schwartz’ board members from the Roanoke Chowan Community Health Center in Ahoskie drove several hours to speak to their local representative, Howard Hunter III (D-Ahoskie).
“They’re here from Hertford County, and that’s where Howard is from,” said Schwartz, who is the executive director of RCCHC. “They knew his dad, they raised Howard. They were like, ‘OK Howie, what are we gonna do here?’
“There’s no running away. They’ve known him since he was a little boy and they’re holding him to ‘remember us.’”
Schwartz was still concerned, though. Rural folks gave Republicans their edge in both the national and the state races in November, but her conversations with lawmakers revealed, that for many of them, the rhetoric hasn’t really changed.
“What I’ve heard today is that they really don’t care about Medicaid,” said Schwartz, who has sat on the state Medical Care Advisory Committee, which provides feedback about the Medicaid program.
“What we’re hearing and feeling in the committee, that it’s a budget issue, not an access issue, which is the same old story.”