Stuart Johnson, Deseret News
This is the final part of a Deseret News series that examines how Utahns are empowering our poor in three areas: homelessness, education and health care.
SALT LAKE — It's 8 a.m. on a freezing-cold Sunday beneath the 500 South viaduct. Under the shelter of the overpass, a line of volunteers, their breaths clearly visible in the cold air, are serving breakfast on cardboard plates to the homeless.
But not everyone's focused on the tempting aroma of the hot buttermilk pancakes and meaty gravy that's being scooped over mashed potatoes. Bob, a tall, skinny man in a tattered gray coat, is searching for the nurse who sometimes shows up. He's got a bad rash, he says, pushing up his sleeve to show a volunteer the angry red bumps from his wrist to his elbow. Sometimes the nurse gives him ointment that helps.
A few minutes later, a harried mom pushing an overstuffed stroller with a toddler sitting beside what looks like a trash bag full of clothes makes the same request. Did the nurse come?
When you're poor and uninsured or underinsured, health care can be a vexing problem.
Last year in Utah there were 387,100 people without insurance, including 100,500 children, according to the Kaiser Family Foundation. Of those, 71 percent were in families with at least one full-time worker. Another 12 percent were in families where someone worked part-time. Most of the uninsured are poor.
And even when there's help, it may not be complete. While 10 percent of the state's population has Medicaid, there are gaps in what it covers. Many low-income folks don't qualify for Medicaid or for the Children's Health Insurance Program. Barring the ability to get health insurance through an employer or afford it on their own, they slip through some good-sized cracks when it comes to accessing medical care.
It's particularly true for poor working-age men and women, many of whom work for wages low enough they can't rise above the federal poverty guidelines. They compound the problem by putting off going to a doctor or getting screenings because they can't afford it. Some only go when they have more advanced and costly medical needs. Or they may use emergency rooms, which are a great deal more expensive than nearly any other option, as an entry point into the health care system. Some go there because the medical problem becomes a crisis, while others may not know where else to go. And if they cannot afford to pay for the care, some of the cost gets passed on to the paying customers in the form of higher costs.
That ER utilization is one reason government agencies and health care providers support or offer health fairs and clinics in the community, from the Fourth Street Clinic to serve the homeless to the network of Community Health Centers like Midtown in Ogden and Central City in Salt Lake. A powerful line of care for the poor, they leverage local and federal money, as well as donations, and provide service based on a patient's ability to pay, using a sliding fee. But clinics can't just operate on fumes and good wishes. They must be what Intermountain Healthcare's community clinics director Terry Foust calls "financially viable" if they're to stay open. They can't just see patients who need free service, he said. There are real costs associated with stitching arms and treating disease.
School might seem a funny place to establish a medical home, but that has proven to be an effective and accessible choice for low-income inner-city residents in the neighborhoods around Rose Park and Lincoln elementary schools, where Intermountain Healthcare has done just that. A string of community and school-based clinics stretches from Logan to St. George, said Foust. There's a clinic in Dixon Middle School in Provo and they've teamed up with a community health clinic in Ogden to provide services at James Madison Elementary, which also hosts a major community-wide health screening event over a couple of days each year. In most cases, charges are based on income level.
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