Virginia can't afford holes in health safety net

I am probably like most Americans who are fortunate enough to have health insurance for their families in that I used to give little thought to how the poor and the struggling managed to get health care. That changed when I was asked to join the Board of CrossOver Health Care Ministry.

To find out more about the organization I talked with Dr. Dan Jannuzzi, CrossOver's longtime medical director. I was interested in why he had stayed so long at what must be a tremendous financial cost to him and his family. He related an incident that occurred over 20 years ago but was still fresh in his mind.

A new patient had come to the clinic, desperately poor and unable to afford medicine for a serious but treatable condition. Jannuzzi was asking some questions to get to know him when the man hung his head and said simply, "I'm homeless. I'm not human." At that moment Jannuzzi realized that there was more going on at CrossOver than just practicing medicine. "We are restoring human dignity," he told me.

Jannuzzi and the dedicated staff at CrossOver teamed with hundreds of volunteer doctors, dentists, pharmacists and nurses to provide compassionate, high-quality, free medical care, and help restore a measure of human dignity, to nearly 6,000 Virginians last year. It is something to behold, and its future should not be at risk.

Free clinics like CrossOver play a vital role in the delivery of health care in our commonwealth. Together with community health centers in rural and underserved areas — both backed by support from the Virginia Health Care Foundation in the form of direct grants and innovative programs that augment their capabilities — they are the source of primary health care for an often forgotten segment of our population, the uninsured and underinsured, reducing the burden both on government and on our hospitals.

Some, like Jannuzzi's patient, are homeless. Others are hard-working single parents, struggling to raise a family on an income that disqualifies them for Medicaid but makes health insurance an unattainable luxury.

Still others have lost their jobs, and their health insurance, in the wake of the economic crisis. And then there are those who have insurance but cannot afford to meet the cost of their deductibles and co-payments. In many cases they have serious health issues such as diabetes, heart disease and other chronic illnesses.

Without access to a free clinic or community health center, they have nowhere to go but a hospital emergency room, often after their conditions have deteriorated, requiring costly treatment that could have been avoided with early intervention.

Together Virginia's 59 free clinics and 29 community health centers provided free or low-cost care to nearly 200,000 such Virginians last year. This health care safety net has been woven over two decades of thoughtful bipartisan cooperation in the best Virginia tradition of public/private partnership. But the recession has stretched the safety net to the limit.

In 2010, free clinics alone had to turn away more than 10,000 Virginians because of a lack of resources. Even so, the legislature is now considering a reduction in funding for free clinics, community health centers and the Virginia Health Care Foundation.

Looming like a fog over those discussions is President Obama's health care reform. A goal of the Affordable Care Act is said to be a reduction in the number of uninsured. But too many questions remain for the legislature to start unraveling the safety net just yet. Will the act be overturned by the Supreme Court? Or will the court uphold it, or part of it? How will the administration and Congress respond to the Court's decision?

Without answers to these questions budget writers are operating in a vacuum. No one knows for sure what the parameters are going to be. Free clinics and community health centers might have to play an even greater role under health care reform. A study commissioned by the state's Health and Human Resources department estimates that the number of uninsured will continue to exceed the capacity of the health care safety net, even if health care reform is fully implemented.

The commonwealth's contribution of a tiny fraction of the budget to the safety net is one of the best investments we make with our public dollars. Donations to free clinics support more than 14,000 volunteer health care workers, resulting in $6 of care for uninsured and underinsured Virginians for every dollar spent.

The Virginia Health Care Foundation has a 20-year record of leveraging every dollar into $11 in cash, health services, and other in-kind contributions. Nationwide, it is estimated that community health centers in rural and underserved areas save billions in health costs.

In the uncertain environment surrounding heath care today, the legislature should keep the safety net intact. As budget writers meet to consider the budget for the upcoming biennium, a top priority should be preserving funding for free clinics, community health centers and the Virginia Health Care Foundation. People's lives are depending on it.