Health care for all: caring for the uninsured

As Jack Metzgar wrote last week, health coverage is an important issue for the working class.  As health insurance becomes less available and as urban hospitals around the country restructure, working-class people are bearing the brunt of the health care crisis.  The situation here in Youngstown is a case in point.

Forum Health is the largest health care network in the Youngstown-Warren area. Like other urban health care networks, it has been faced with “radical restructuring” that disproportionately impacts the poor, the working class, people of color, and the elderly. Should parts of Forum Health close, Youngstown’s other major hospital, Humility of Mary Health Partners and the Ohio North East Health Systems, would have to shoulder an ever greater share of the areas $81 million charity care.

In 2006, when the restructuring plans were announced, Sherry Linkon and I argued that access to health care was public health issue (Op-ed “Questions raised by Forum’s Restructuring” The Vindicator, 4/08/06).  We proposed that local leaders and regional Boards of Public Health should develop a comprehensive community health care network. Two years later, I’m pleased to see just such a system being created in our area.

In 2007, a group called the Mahoning Valley Access to Care coalition (MVACC), with representatives from the areas’ major healthcare providers, began to gather information and develop a guide to local health care resources. With assistance from the United Way and local healthcare providers, they created the Mahoning Valley Resource Guide.  It was distributed at a recent “summit” on community access attended by over 150 people.

At the summit, MVACC took the next step in developing a community health care system by bringing together community leaders and speakers from other Ohio communities (Akron and Toledo) that had already created such networks.  The most interesting model was the Toledo-Lucas County Carenet. It provides “comprehensive access to healthcare for low-income residents” who are uninsured and do not qualify for other government healthcare programs. By coordinating access to charity care through its providers at no-cost or reduced rates, Carenet dramatically increased primary care visits and outpatient services while simultaneously reducing inpatient days and emergency room visits between 2004 and 2007.  Carenet succeeded in expanding basic care for the uninsured while reducing health care costs. As Carenet Executive Director Jan Ruma explained, the success of program shows what can be done if people work together, if organization and community leaders will pursue the community’s interests instead of their own, and if each organization and health care provider contributes and is held accountable.

The Carenet model can not replace the need for universal health care.  But its cooperative approach can provide a stopgap. The need for access to low-cost health care is growing, as more middle-class workers, like the working class, are losing access to health insurance amid a struggling economy.  A September report entitled “Income, Poverty, and Health Insurance Coverage in the United States 2007,” details the challenge:  long term inequality is rising, median household income is falling, and fewer employers are providing subsidized health insurance.  As a result, the ranks of uninsured, underinsured, and those of Medicaid have increased dramatically. This isn’t just about whether you can get treatment for a cold.  Researchers have long understood that socioeconomic condition contributes to your overall physical and mental health and life expectancy.  Unless we find a way to give more people access to health care, our well-being and longevity will falter.  As economic conditions become harsher, and as health care providers become more stressed, the need for community care models grows.  Such approaches may fill the gap, but ultimately, we all need universal health coverage.  And that’s not just a working-class issue anymore.

John Russo

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