An estimated 5,000 people living in Alexandria are without access to healthcare. Without any assistance from the state, the struggle for many Alexandrians has potential to grow into a city-wide moral and financial crisis. In response, Mayor William Euille has established a Special Advisory Panel on the Health Care Needs of the Uninsured.
“The Virginia Assembly refused to address this, so now 270,000 Virginians are too poor for the Affordable Care act and too rich for Medicaid,” said Committee Chairman Dan Hawkins. “Many of these people are too poor to receive benefits .… Our task is to grapple with that in a feasible and affordable way.”
Tuesday, Feb. 3 in the City Council Workroom was the committee's second meeting. So far, the panel is the only one of its kind in Virginia dedicated to finding a local solution to the statewide lack of healthcare funding.
“We just started, and we’re struggling to define the problem,” Hawkins said, but everyone on the committee seems to agree, at least, that there is a problem. “There is a huge body of data that shows the poor lack access to care, they get sicker, and cost more to care for.”
Part of the frustrations encountered by the committee is that federal tax dollars go to support comprehensive healthcare programs in other states while Virginia has no such program. For Richard Merritt, a member of the panel, that means watching as people with the same level of poverty as many Alexandrians are treated across the Potomac in Maryland and Washington D.C.
For Hawkins, it’s more than a moral problem for the city, it is very quickly becoming an economic one.
“When folks don’t get access to care, like regular checkups or screenings, they end up costing more money in the emergency room,” said Hawkins, quoting a 1972 oil filter advertisement “’You can pay me now, or you can pay me later.’”
As the group begins to look for solutions to the uninsured crisis, one of the main challenges will be strict resource limitations. With the city anticipating a budget shortfall to work around, Hawkins is uncertain about the City Council’s potential willingness to fund a new program. But sooner or later, Hawkins says, it’s a cost the city is going to face. According to Hawkins, the longer it takes to address that, the more costly it will be.
One of the panel specialists, Mary Anne Weber, said one of the other problems the committee is likely to face is a lack of medical care available, particularly for those suffering from mental health issues.
“There are not enough hospital beds in communities, and these people shouldn’t have to be shipped off to state institutions,” said Weber. “All of the data we have says people recover better in their own communities.”
Basim Khan, the interim executive director and medical director for Neighborhood Health, formerly Alexandria Neighborhood Health Services Inc., said another major problem the group will have to contend with is a lack of specialty care. Finding specialty care for many chronic diseases can already be difficult. For those without insurance, it can be almost impossible.
“Patients without insurance will have to go to the University of Virginia or Richmond for specialty care,” said Khan. “For people working daily, that’s a big cost.”
Merritt, former chair of the Alexandria Public Health Advisory Commission, said the first step in helping to secure resources to combat the lack of healthcare is dispelling the untrue assumptions about Alexandria’s uninsured.
“There are myths about who the uninsured are,” said Merritt, primarily that those who are uninsured are also unemployed. “Seventy percent of people who are uninsured are working either part or full time and their employer either can’t or won’t provide them health care benefits.”
The second myth, Merritt said, is that Alexandria’s “strong safety net” will take care of those with medical issues who don’t have insurance.
“We do have a strong safety net,” said Merritt, “but that doesn’t provide at all for primary or specialty care.”
After the panel argues for whatever resources they can get from the city, Hawkins says they’ll be put in the uncomfortable position of establishing priorities within the uninsured community.
“We’ll take those at highest risk, namely with more than one disease, and we’ll look for the highest number of chronic conditions,” said Hawkins, noting that diabetes and high blood pressure can often be accompanied by depression, and vice versa. Weber added that depression medicine can sometimes directly lead to diabetes or high blood pressure.
But there is also a careful balance the group will have to strike in its prioritization. The group will also have to provide some level of regular care to those at low risk in the community to keep them from becoming high risk patients.
A few programs already exist in Virginia to help those in need of medical attention. One, the Governor’s Access Plan (GAP), is a pilot project for those suffering from serious mental illnesses that gets health care access to those who don’t otherwise qualify for Medicaid. To receive GAP benefits, an adult citizen must be between 21 and 64 with no health insurance, a household below 100 percent of federal poverty level ($11,670 per year for a single adult) who is no longer residing in a long term care, mental health, or penal facility. Applicants must also go through a screening process to meet the criteria for serious mental illnesses.
Enroll Virginia also helps local citizens discover if they qualify for healthcare coverage and, if they don’t, where they can go for treatment. Enroll Virginia assists all uninsured individuals enroll in affordable health insurance programs for free and provides in-person assistance with enrollment at businesses and community organizations. The deadline for special enrollment to receive tax credits is Feb. 15.