Access, affordability challenge for patients

In its annual report for 2014, the Dungeness Health and Wellness Clinic, which serves uninsured and underinsured patients, saw its urgent care visits decrease by 34 percent and its chronic care visits drop by 28 percent over 2013.

That begs the question: Is there less of a need for its free medical services by the working poor and if so, why?

“It’s a mixed bag,” said Rose Gibbs, RN, the clinic’s director. “With the Affordable Care Act, some of our lower-income working people have had a chance to qualify and a lot were able to do it. In early 2014, they were able to get into a (primary care) provider but that came to a crashing halt later in the year because the demand for providers exceeded the supply.”

The impact of the ACA was a double-edged sword — good because many previously denied patients could qualify for health care insurance but bad because there were no local providers to take them. Lack of access became the real challenge.

“Toward the end of the year it got worse and it’s pretty bad now. Although the area has recruited providers, the demand is still higher than supply,” Gibbs said.

In the year-end report, she states, “Approximately 65 … have enrolled in health care coverage since January 2014 … Most have found primary care providers; however, in recent months, they have been placed on waiting lists or scheduled for a first appointment in nine months.”

For the very low income, there is Medicaid, now called Apple Health in Washington. For those “working poor” who don’t qualify for Apple Health, many in minimum wage jobs whose employers don’t offer insurance or those workers who can’t afford the premiums, the ACA was touted as an important alternative. Gibbs begs to disagree.

“The Affordable Care Act is a misnomer — for many it’s not affordable,” Gibbs said. “Many patients can’t pay the premiums of $400-$800 a month plus a $5,000 yearly deductible. When the government tried to ‘reform’ health care, the only thing it changed was insurance plans — not outcome, not access. The rural area we live in has challenges a city may not, demand exceeds access to health care. Even the well-insured can’t get in for an appointment because of access. In the evening urgent care clinic, about 50 percent are new patients, some searching for a PCP (primary care provider) or they don’t have any coverage at all.”

From the Washington Health Care Exchange, established as a result of the ACA, it says, “… cost-sharing subsidies reduce the out-of-pocket amount of expenses you have to pay when you receive health care services at the hospital or doctor’s office. You can get this reduction if you purchase a Silver plan through Washington Healthplanfinder and if your income is below a certain level.”

However, Gibbs noted, “Many find that they do not qualify for subsidies and cannot afford the insurance product. Exchanges are so expensive that unless their employer is paying for their insurance, many are just not going to enroll or pay the co-pays for follow-up care. We see people who have waited to come in and now present with complex medical issues.

Gibbs added, “We’re the safety net for people who can’t afford it or who don’t want to get into the government system. We see very few people ‘down and out’ — usually most of our patients — 90 percent — are ages 18-64 and patients from ages 20-45, working and with young families, are really being hit hard because they’re usually in part-time jobs, they’ve recently lost their jobs or their hours have been cut. Combined incomes of married couples also may put them above the amount to qualify for a subsidy and buying into the exchange becomes unaffordable.”

Gibbs said, “The system has to bring the reality of costs into it. Fewer and fewer physicians are accepting new Medicare and Medicaid patients nationwide because of mandates by Congress to reduce reimbursements. Reimbursements are below the cost of providing the service, as much as 30 to 50 percent less than the actual costs.”

Gibbs said the Olympic Medical Physician Walk-in Clinic in Sequim helps somewhat with access, but if patients present with chronic problems and aren’t able to establish with a primary care physician, “it puts them in a really bad place because there’s no one to send them to for follow-up. The Walk-in Clinic is not able to become their primary,” Gibbs said. “We will see Medicare and Medicaid patients a few times, but we can’t be their long-term primary care provider.”

Gibbs is grateful for the assistance of Olympic Medical Center and its support which provides the clinic assistance by way of nominal rent and covering basic labs and X-rays. She said the clinic wouldn’t exist without OMC’s support.

As for 2015, Gibbs forecasts a year much like last year. “People are not getting into new coverages because the exchanges are very expensive. We are being sought by those who received partial subsidies and catastrophic plans and are now finding it prohibitive to afford co-pays and deductibles.”

Also for those who obtain coverage, they are not able to get appointments with a PCP for six to nine months, she said.

In 2014, the clinic had 1,386 patient visits and Gibbs expects its 75 volunteers will continue to attend to the health care needs of the uninsured and underinsured of eastern Clallam County.

“This is a great service for the community and people need to be really proud of what we do,” Gibbs said. “I love what we do. The patients are so thankful and they appreciate the friendly support and services they receive from us. Dungeness Valley Health & Wellness Clinic will continue to be a beacon of health and a beacon of hope for the underserved in Clallam County.”

Dungeness Health & Wellness Clinic

Location: 777 N. Fifth Ave., in the rear

Phone: 582-0218

• Basic Urgent Care Clinic hours:

Monday and Thursday

Drop-in beginning at 4:45 p.m.

Patients seen first-come, first-served beginning at 5 p.m.

• Chronic Healthcare Clinic hours:

Visits by appointment Tuesdays from noon-4:30 p.m.; first three Thursdays from noon-4:30 p.m.

Whom the Dungeness Health & Wellness clinic serves

Intake statistics show that:

• 69 percent of patients are under the age of 50