Health care for the poor: Communities seek solutions

When Aetna CEO Mark Bertolini visited his company’s offices around the country, he was struck by the struggles of some of his employees — such as single moms working in his call centers who used food stamps or had to enroll their children in Medicaid.

It’s one of the many ways companies, cities and states are trying to come up with solutions to help ensure the working poor get the health care they need — even in states that haven’t expanded Medicaid.

One of those states is Alabama, where the city of Birmingham also raised its minimum wage after labor groups cited the lack of health care for low-income workers. With hourly wages of $10.10 an hour, activists such as LaDarius Hilliard argued that some low-wage workers could at least buy heavily subsidized health insurance on the federal insurance exchange.

Meanwhile, Alabama’s Republican governor, Robert Bentley — citing the plight of the working poor — said in November he’s looking at Medicaid expansion after years of resistance although he hasn’t made a final decision..

Texas has said no to the expansion all along, but Harris County, which includes Houston, offers a taxpayer-funded “Gold Card” insurance program that provides help on a sliding scale for low-income residents. But beginning next March, Harris Health System, which runs the program, is reducing the maximum income level to qualify, meaning fewer people will be eligible.

One Gold Card recipient is Diantha Brennan of Houston, who was a practicing lawyer until she was derailed by depression and diabetes. She eventually wound up uninsured, living in low-income housing and making just a few dollars working part time as a home health aide for someone else with diabetes. Across the street from her apartment complex is the courthouse, where she eventually hopes to practice law again.

At times, she’s struggled to keep her diabetes under control and her blood sugar once shot so high that she needed to be rushed to the hospital in an ambulance. She’s also wound up having to eat at the church food program to which her family once donated. She says she’s grateful for her Gold Card but would love to see Texas expand Medicaid as a more permanent solution, since “basic care doesn’t seem to be available to all of us.”

Besides the county insurance program, the working poor in Houston can also use a food pantry designed specifically for them. On the campus of the Houston Food Bank, America’s largest, the pantry looks like any small grocery store brimming with produce, canned goods and cereal — except for the long lines that form more than an hour before it opens.

Jonathan Alvarez of Houston was waiting in that line one afternoon last summer. The former phone repair worker had just taken a job at Wendy’s, working part time 36 hours for $8 an hour – income that would have made him eligible for Medicaid if the state had expanded the program. But he was uninsured, so he avoided seeking medical care even when he was sick, opting instead for home remedies.

“I fear the hospital because of the serious medical bills they give you,” he said.

When people face such overwhelming obstacles as hunger or eviction, it’s hard to get them to focus on their blood pressure or sugar levels until there’s a costly crisis. That’s why hospitals such as Montefiore in New York City are providing them with the social services they need to keep them healthy and out of the emergency room, a far more expensive alternative for everyone.

Montefiore’s Housing at Risk program partnered with community organizations such as Bronx Works to pay $3,000 in past rent for Jorge Telmerpaz, a laid-off construction worker who had cirrhosis of the liver and now has cancer. State funds to redesign Medicaid were used to cover two-thirds of his rent.

«Even our patients are shocked when we come in to meet with them and say, ‘we’re here to meet with you about housing,'» says Bernice Asamoah, a project manager with Montefiore’s department of social services, «They look at me and say, ‘Since when does the hospital help people with housing?'»

Montefiore also has a $5.6 million Center for Medicare and Medicaid Services’ innovation grant to help place behavioral health experts, such as psychiatrists, psychologists or social workers, in all of their primary care offices to better coordinate care. Depressed people aren’t going to take their diabetes and other medications, says psychiatrist Brian Wong who is director of adult behavioral health services for the Montefiore Medical Group.

Many health experts say these sorts of programs are only part of the answer; there also has to be a commitment by companies and governments on all levels to ensure the working poor have reliable health coverage for the long term.

Terry Dunn, past chair of the Kansas City Chamber of Commerce, says a more permanent solution is critical.

«The message we’re sending (now) is that we don’t want to address health care issues for our poor,» Dunn says of Kansas and Missouri’s decisions not to expand Medicaid or find another healthcare solution. «This is an economic issue. Companies looking to relocate want to be in progressive states.»

Meanwhile, in Texas, which also didn’t expand Medicaid, community groups struggle to help poor people left behind.

Renae Nelson, CEO of My Brother’s Keeper outreach center in Houston, says people in her area are «destitute in hospitals needing health care they can’t afford, and we’re not able to help them as much as we want to because we’re needing to keep the doors open ourselves.»