The Doctor Will See You Now-For Free

As the number of people without health insurance rises, local doctors have banded together to help out. But it is a Sisyphean struggle

Seven years ago, Catherine Moore (not her real name) was an ordinary middle-class mom. She had two older children in college and a nine-year-old son at home. She had a part-time job at a custom framing business and a hard-working husband, a master carpenter with a steady income. She had health insurance. And she had no clue that America’s healthcare crisis was headed straight for her front door.

One day in 2000, Moore’s husband fell backwards off of a ladder and cracked his head. His brain hemorrhaged, and he sank into a coma.
 

“It changed our lives,” Moore says with obvious understatement. She is articulate and has a wide smile, lovely hazel eyes, and shoulder-length auburn hair. Dressed in a well-worn, soft blue sweater, she sits in a coffee shop on Central Avenue, telling her unhappy story without a trace of self-pity.

When her husband regained consciousness, he had to learn how to walk and talk all over again. As a subcontractor, he was not covered by the general contractor’s workers’ compensation insurance and he had no coverage of his own. “My husband’s income, which we had counted on, was gone. It ruined us financially.” Suddenly, Moore was “sucked into this whirlwind,” trying to work, care for her husband, and rear her fourth-grader. “I spent a lot of time in hospitals.” Three times she applied for disability income for her husband. Three times she was denied.

As her husband slowly recovered, he became depressed and started to drink. The situation deteriorated until Moore made a grim decision. “I looked at it like I was out on a ship, and it was going down. I could either save my husband or I could save my son,” she says. “Ultimately, I realized that I had to save myself and I had to save my son, because I could not save my husband. Nothing I was doing was helping.” In fact, Moore’s small income was hindering her husband from qualifying for federal assistance. In 2004, they divorced.

Moore, who is fifty-two, now works forty hours a week at two different framing shops, making $472 per week. Because the jobs are part-time, the businesses do not provide health insurance. She can’t afford her own premiums. “And because I earn too much to receive a government-subsidized program,” she says, “it puts me in this great big hole.”

Physicians Reach Out has thrown her a rope. Now in its third year, Physicians Reach Out (PRO) and groups like it are trying to bridge the ever-widening chasm created by spiraling healthcare costs and an exorbitant number of people without health insurance. Through PRO, doctors, hospitals, and healthcare technicians provide free or almost-free medical services to low-income, uninsured residents of Mecklenburg County. To receive PRO assistance, a person cannot qualify for Medicaid or any other health insurance coverage and must earn no more than twice the Federal Poverty Level. (The Federal Poverty Level for an individual is an annual income of $9,570; $19,350 for a family of four.)

Eligible patients receive a card that operates like an insurance card. With the card, visits to participating doctors’ offices are free; services such as hospitalization or diagnostic tests are charged on a sliding scale based on the patient’s income level.

“We look and act like an insurance company,” says PRO Director Byron Grimmett. “But the big, big difference is we don’t give [healthcare providers] any money.”

According to the census bureau, the number of uninsured Americans rose in 2005 for the fifth year in a row, to 46.6 million. North Carolina, with more than a million uninsured adults, has the second fastest-growing population of uninsured residents in the United States. In Mecklenburg County, 17 percent of the adult population was uninsured in 2004, the most recent year for which data is available.

But our national healthcare crisis isn’t about numbers. It’s about people, like Moore, trapped by low wages and poor health, and the people, like Grimmett and John Klimas, who are trying to rescue them.

Dr. John Klimas, a trim, silver-haired allergy and immunology specialist, ambles through a maze of corridors to his small, bright office in the Carolina Asthma and Allergy Center. The walls are decorated with awards and certificates for his medical achievements. Pictures of his children and grandchildren line the mahogany bookshelves behind his desk. Klimas, fifty-nine, sits down and spins his computer screen around to display the motto of the Order of Malta, a Catholic institution, dating to medieval times, devoted to helping the poor and the sick. As a member of the order, he is guided by that mission.

“The two biggest problems in medicine today are costs and access to healthcare,” he says. “So I started working on those problems.”
 In the late 1980s, Klimas began volunteering in a local homeless shelter. “It was very frustrating. I called it BAND-AID therapy,” he says. “There were people with chronic diabetes, acute infections. You’d see them one week and treat them, but they’d be back the next week.” He continued to work at the shelter for nearly a decade, but he wanted to develop an organized network that would provide consistent care.

In 1996, the medical community in Asheville created an outreach program called Project Access. Klimas studied it, and Project Access became the prototype for PRO. It took several years to get organized. A $500,000 grant from the Duke Endowment provided start-up money.

Convincing the notoriously competitive Presbyterian and the Carolinas Medical Center hospital systems to work together was “a tremendous feat,” Klimas says. That accomplished, in September 2004, the Mecklenburg County Medical Society launched PRO with more than 700 doctors. Now more than 1,000 physicians, about 60 percent of the doctors in Mecklenburg County, participate, along with the hospitals, physical therapists, and technical service providers such as Charlotte Radiology.

“I think physicians have special roles as citizens,” Klimas says. “At a local level, you have certain responsibilities.” He says some doctors have rejected the program. “We’ve had issues with some groups that haven’t wanted to see patients. We don’t do arm-twisting.” PRO accepts clients regardless of immigration status (it simply doesn’t ask), a practice some physicians find objectionable. Other doctors are concerned about malpractice suits.

But, on the whole, the medical community has been eager to help. As president of the Mecklenburg County Medical Society, Klimas would often speak to groups of doctors. “I would ask, ‘How many of you see patients free of charge?’ Almost everyone raised their hand. It happened in Charlotte every day.”

Since PRO’s inception, participating healthcare providers have donated some $7 million worth of medical services. Much of that care is from specialists, a characteristic that distinguishes the PRO network from the various free medical clinics in the county. In addition, patients receive care at the medical offices, where they are treated just like insured patients. That’s what PRO Director Grimmett calls “the dignity component.”

“We try to make it so smooth that you would hardly even know whether it was a PRO patient or a regular patient. And sometimes the doctors don’t know,” says Klimas.

“The whole staff—they’ve always treated me with respect and kindness,” says Moore, who is now a regular patient at Mint Hill Family Practice. “When you’re an independent spirit, you have to kind of swallow your pride in some ways. I have to work on that every day.”
In return, PRO demands a high level of responsibility from the patients. At some clinics only half of the patients show up for their appointments, says Klimas, so in PRO, patients who miss more than two consecutive appointments without giving twenty-four hour notice can be dropped from the program. The low-income uninsured often go to the emergency room for routine medical care, a practice that costs taxpayers millions of dollars. PRO patients who choose the emergency room for non-emergencies can lose their PRO coverage. Patients are reevaluated every six months to renew their eligibility.

It’s 11 a.m. on a December morning, and Margarita Martinez, an energetic, twenty-five-year-old AmeriCorps volunteer, is meeting renewal applicants in her small gray cubicle in the PRO office uptown. Earlier that morning, she had reviewed the application of a blind man who had been turned down three times for Social Security Disability Insurance. Now she talks to a young Latina woman with short chestnut hair and a friendly smile. More than half of all PRO patients are women, and 48 percent are Hispanic.

Martinez, whose father is Mexican and mother is American, speaks Spanish with the woman as she reviews her employment status and helps her locate an ophthalmologist’s office. She sees an average of fifteen applicants a day.

“It’s a way of keeping in touch,” she says. “This population is very mobile. The renewal process allows me to follow their progress.”
On the back of her chair hangs a red wool jacket, with a deep purple scarf draped over it. The scarf was a gift from Catherine Moore. At her renewal meeting a few months earlier, Moore was terrified that a recent fifty-cent-per-hour raise at one of her frame shop jobs would threaten her PRO eligibility. With arthritis and a thyroid condition, she needs that coverage. Martinez could tell Moore was upset. “She just reached out and put her hand on my shoulder and said, ‘It’s going to be okay’,” says Moore. Moore was touched by the show of compassion and knitted Martinez the scarf in gratitude. “I do believe in angels and I do believe they walk the earth,” Moore says.

“Margarita Martinez is an angel from heaven.”

Martinez is one of two AmeriCorps volunteers who work at PRO along with five full-time staff members. At the end of 2006, PRO was serving approximately 1,600 clients. Grimmett hopes the organization’s $500,000 annual budget, funded through national and local grants and money from both the county and the state, will increase enough to hire three additional staff in the near future. Even at that size, Grimmett says PRO could serve only between 4,000 and 5,000 clients, fewer than a third of the Mecklenburg County residents who qualify. That’s why, say advocates for affordable health insurance coverage, organizations like PRO are ultimately not the answer to the current healthcare emergency.

“Anytime that providers are willing to help those who have no health insurance, that’s a good thing,” says Kathleen Stoll, director of health policy for Families U.S.A., a national advocacy group. “However, it is not a long-term solution to rely on a system that is voluntary and charitable. It’s a BAND-AID on a bleeding wound.”

Klimas looks forward to the day when that wound will heal, and PRO will be unnecessary. “We are currently a safety-net program. As time goes by, I hope and pray that our medical system will improve so that all people will get good quality medical care and PRO will be phased out. In the meantime, I’m just trying to help now.”