First Posted: 1/15/2009
FAIRMONT - “Not having health insurance is the great equalizer … It doesn't care what race you are or how much money you make.”
Jenny Lowery, the CEO of South Robeson Medical Center, has seen all races, mostly the working poor, come through her organization's door, hat in hand, unable to pay for needed medical services. And she's seen folks who by most accounts are relatively well off financially - folks who never thought they'd be without health insurance.
“We see a lot of people who have always had insurance and all of a sudden they don't,” Lowery said. “It's emotionally devastating. You've got people who worked at Converse for years and had insurance. They built their homes and raised their families and had insurance and then it was gone.”
South Robeson Medical Center, with offices in Fairmont, Lumberton, Maxton and Pembroke, is one of the agencies that helps the legion of Robesonians who fall through the cracks of the health care system because they don't have health insurance or the means to pay for medical service.
In Robeson County, that “legion” amounts to almost 28,000 folks, or about 25 percent of the population without health insurance. That figure gives Robeson County the second highest percentage of uninsured in the state, second only to Duplin County's 26 percent. Lowery says South Robeson Medical Center takes a big bite out of the uninsured pie with about 15,000 walk-ins a year.
Funded by the federal government to the tune of about $1.4 million a year, South Robeson Medical Center offers a “sliding scale” for patients without health insurance, in which they pay only what they can afford for medical care.
“We have to verify what their family size is and what their family income is and then we have a sliding scale that says if you fall in this range, we can discount your medical care 10 percent, 20 percent, whatever,” Lowery said. “That includes the medical visit, X-rays, injections, or any type of procedure we can do in-house. You could easily have a procedure that would cost $300 and you only have to pay 10 percent of the bill.”
Lowery stresses that South Robeson Medical Center is not a free clinic. In addition to offering discounted medical services based on a family's size and income, the clinic also offers the federally funded 340B Pharmacy Program, which lets the center contract with local pharmacies to offer discounted medications to patients without insurance. The discounts range from 35 to 45 percent, said Lowery.
“We tried to pay for medications years ago and it almost broke us,” Lowery said. “Most of our patients come in and have everything in the world with them and most of these medications are so expensive. We got to the point where we almost had to close our doors.”
In addition to the South Robeson Medical Center in Fairmont, the corporation's other clinics include Maxton Medical Center, Julian T. Pierce Health Center in Pembroke and Lumberton Health Center.
South Robeson Medical Center isn't the only Robeson County entity offering help to the uninsured.
Southeastern Regional Medical Center has staff - six benefit advisors, three financial counselors and three Department of Social Services workers - to help the uninsured.
Ann Stephens, SRMC spokesman, said the medical center does what it can to help the uninsured review their needs and complete applications for programs for which they may be eligible.
“One thing we try to do is see what programs people may qualify for and enroll them if they meet the requirements,” Stephens said. “We also have programs like the Pharmacy Care Clinic which helps people get medicines through certain drug company programs if you meet certain criteria.”
Stephens says that unless a person is suffering a true emergency, the uninsured should go to one of SRMC's five clinics instead of the hospital's emergency room: the Dr. A.J. Robinson Medical Clinic in Lumberton; the Fairmont Medical Clinic; the Johnson Medical Clinic in Red Springs; the St. Pauls Medical Clinic; or the Rowland Medical Clinic.
“It would probably be quicker for them,” Stephens said.
Grover Godwin, practice administrator for Lumberton Radiology Associates, said most doctor's offices will try to work with those without insurance.
“We don't provide free service, but we certainly don't turn anyone away,” Godwin said.
What the clinic does is set up payment plans for uninsured patients. Those who can pay something up front are given discounts.
“It would be much better if people had insurance because trying to collect is expensive and can be a big headache,” Godwin said. “But we also realize that we are providing the women of Robeson County a very important service and we will work with them to get them the proper health care that they need.”
While it's agreed that most of the patients making up the county's uninsured are classified as the working poor, it is an issue that affects everyone.
A study done by the U.S. Institute of Medicine last year said the uninsured cost the nation almost $130 billion a year in medical expenses and lost productivity, factors which drive up health costs and insurance premiums that affect everyone.
Lowery said adding to the cost are the newly implemented patient privacy, or HIPPA, rules that make the paperwork maze of providing health care that much more expensive and complicated.
The plight of Sara, a woman who asked that only her first name be used, illustrates how difficult navigating through the insurance minutiae can be for even educated people.
When the former professor moved from California to Lumberton in August to start a business, she needed to switch to a North Carolina health plan.
“Trying to sort out the plans was crazy,” she said. “And if you're honest about an existing medical condition, you can forget it. They won't deny you coverage, but they will make the premiums so high that it is cost prohibitive. They wanted $2,500 a month to insure me. I have never been disabled and my problem was easily treatable, but you would have thought I had had cancer four times and a bad heart.”
If it's complicated for a college professor from the United States, imagine how difficult it is for a stranger to this country to navigate the labyrinth that is health care. To help guide the influx of Hispanic immigrants pouring into Robeson County - most of whom have no health insurance - South Robeson Medical Center has implemented a migrant outreach program which has been operating for about five years.
Under the auspices of the program, outreach workers go to farms and work with Hispanics to tell them what health services are available to them, train them about pesticide poisoning, dehydration, nicotine poisoning from green tobacco leafs, hygiene, etc. Lowery says it is hoped that through education the number of Hispanics without insurance needing medical care will be reduced.
“We're seeing more and more Hispanic patients … One year, 1 percent were Hispanic, now it's up to 10 percent,” said Lowery, who adds that the clinic has interpreters for their Hispanic patients, which further increases health costs.
Dr. Robin Peace, who works at Maxton Medical Center, has watched the influx of Hispanics, as well as an ever increasing number of working poor, swell her waiting room. And she only expects those numbers to increase until better jobs that offer health insurance come to the county.
“There has got to be more jobs that offer more benefits,” Peace said. “There are a lot of people in this county who want to work who can't find it.
“There are many fast food workers with absolutely no health insurance and there are a lot of people that own their own businesses who can't afford insurance. The lack of health insurance is epidemic and it's very rewarding to do what we can to help these people without any insurance, but I'm afraid that sometimes it's like sticking your finger in a dike.”