Health Care Safety Nets Focuses on Poor Leaving Out The Middle Class

Have you ever noticed how the Health Care Safety Nets such as "Free" Clinics, Medicaid, Medicare, and other such programs are touted as a "Safety Net" to "Prevent people from going without health care" and to "assist citizens in local communities"? I have seen these programs touted by government officials and some government employees as a safety catch-all that will supposedly help everyone. They receive commendations for their innovation and serving the citizens that can't afford to pay for health care. They are great things, really, they provide a service to SOME of the citizenry and they fulfill a need for a portion of the population. So I am not really speaking ill of them because they are a good thing. My beef is with those who tout them as a complete "safety net" without understanding that they only serve a small portion of a population. I have heard too many people say that "everyone qualifies for something" and that "there are public health programs that will serve those who don't want to pay for insurance"; all such statements really get to me because they are so untrue.

I have researched every "free clinic" in North Carolina. Every single one that I have found has the same criteria for eligibility. In order to obtain services, you have to have income at or below 200% FPR and you must be a resident of the county in which the clinic is located. So let's say you're sick, you need to access health care but you can't afford it, you make an appointment at a clinic and spend the required time filling out paperwork to see if you qualify. If you are poor enough and your condition is not critical or doesn't require anything more than basic care then you can receive health care services at a free or reduced rate. However, if you are middle class or earn more than 200% FPR or you need more than basic care or if you don't live in the right area then you can't receive care from a "free clinic".

Medicaid is critically important for adults that are very poor and earn less than $9004.00 per year and for children, especially children with special health care needs. Many children would not be alive today if the parents didn't make the significant sacrifices to ensure that the children qualified for Medicaid. Medicaid is a well managed program that provides excellent health insurance coverage, especially for children with special health care needs such as Cystic Fibrosis. I don't have anything negative to say about the program, I do wish that it would expand some things that it covers, but it certainly is better than private insurance.

My point is that we are completely lacking any "safety net" for the people who earn more than 200% FPR. Our current Health Care system encourages the poor to remain poor in order to maintain access to services and it encourages those who are not poor enough to qualify to limit their assets and incomes in order to obtain qualification for services. The middle class, or those that earn between 200% and 400% FPR, have limited to no access to health care.

Hospital Charity Care Programs operate a little bit more fairly, that is if the adult that applies for the program doesn't have a child/children with severe special health care needs on disability. They count disability payments as income even though disability law says that the family has to use the disability payments exclusively for the care of the child with the disability and the use is limited to certain criteria. Hospital Charity Care Programs are great for the average middle class adult with a healthy child if that adult meets the other misc. criteria.

So what is available for the middle class self employed adult with a child/children with special health care needs that seriously needs access to health care? Nothing free or at a reduced cost. Adults in that situation are told to give up their careers and try to be smart, talented, and lucky enough to find and hold a job that offers health care even though they may be currently very sick and needing medical care, or get a divorce and either that adult or their spouse disappear, or give up all assets and income and go on welfare, or give up their child/children with special health care needs. Great options there, lets divide families, increase divorce rates, traumatize children, increase unemployment rates, and shatter dreams all to try to gain access to health care.

The current "Safety Net" programs require extensive paperwork and an entire qualification process to be completed to see if a person deserves to obtain services. I find that entire process so morally wrong, requiring a person to jump through paperwork hoops to see if they qualify or deserve health care and opening their entire lives where they have to share everything and explain everything is such an invasion of privacy and it demeans and demoralizes that person. We all deserve access to health care at an affordable price and we shouldn't have to fight and jump through paperwork hoops.

We need truly comprehensive Health Care Reform with a National Public Health Plan that will cover everyone, regardless of income or situation. As a society, we should be more concerned with saving lives and promoting the health and well being of our society than corporate profits and keeping the status quo. I'm just one more voice for the 50 million uninsured, and I fear that without access to affordable health care then I will soon be 1 more silent voice for the 18 thousand people per year that die due to an illness that goes untreated.


Few of us are more than a misfortune away from

medical care induced poverty. Adding to your comments above I'll add that a high percentage of us will, at one time or another, need care from a skilled nursing facility. If one is covered under medicare, the SNF costs can be fully covered for @80 days. After that it's going to cost about $180/day for just the basic services. Lots of folks think Skilled Nursing Facilities are just for the elderly...but if you ever visit one regularly for awhile you'll see lots of "younger" people who've had some misfortune that requires services greater than their families can reasonably provide. In any case, getting SNF covered under medicaid requires a massive effort involving 3-5 years of financial records (depending on whether or not a trust is involved) and an application process that would choke a goat. All said and done, you have to spend everything you've got to get help... possibly/probably leaving yourself and family destitute.

If anyone can reasonably afford it, I'd strongly suggest looking into long term care insurance. there are lots of creative policies out there and the younger you are, the less it will cost. what would you do if a child or spouse had a stroke/auto accident/fall from a horse/rolled over on a tractor/etc and needed real help after getting out of the hospital? How many of you can afford $6000 a month?

Stan Bozarth

1 Medical Emergency From Disaster

I completely agree with you. Many patients with severe Brain Injury and other injuries, diseases, and chronic conditions can not be supported by family members for one reason or another and are then institutionalized in foster care homes, nursing facilities, and hospices. Those costs are extremely expensive and to get any current public health program to cover them requires extensive paperwork and again, jumping through hoops and opening your life to scrutiny. If you are lucky enough to afford private insurance then still getting that policy to pay for it without dropping coverage plus paying the deductables and co-pays is far too expensive for most to afford.

No one expects or plans for the worse case scenario to occur. I didn't plan on my body developing multiple tumors and my autonomic nervious system to stop functioning and begin to degenerate. I didn't plan on a drunk driver driving her car & coming out of nowhere and slamming into our car head on, almost killing my entire family and leaving three of us with permanent injuries. I didn't plan on having four children with severe special health care needs. There's an old saying I heard many years ago that stuck with me, "sh*t happens when we least expect it". Life is crazy like that.

The biggest problem with any form of private insurance is cost and coverage. That is one more reason why we desperately need comprehensive health care reform that includes a public health option that is affordable for everyone on a sliding fee scale based on AGI and that guarantees coverage for everyone regardless of income or situation. That is also why we need Health Care Reform to regulate the insurance industry and the medical system. I am not a fan of big government, but I can think of no other entity that would be better equipped to manage the plan as long as they utilize a Council comprised primarily of health care advocates, self advocates, families with children with special health care needs, and medical providers to oversee the management of that plan.

Individual states currently utilize such Council's to format programs, provide insight and input on issues, and to volunteer within the current systems of care. I would like to see the Federal Council modeled after that.

We are all 1 medical emergency away from financial disaster and it just shouldn't be that way.