By Isabel M. Estrada Portales

The cost of health care is rising, and the number of uninsured is going up with it.

Montgomery County, Maryland, has a population 927,583. According to Census figures, in 2005 the median income for a household in the county was $82,187, and the median income for a family was $98,662. That's almost double the country's figures.

But in affluent Montgomery County, Maryland, 80,000 to 100,000 residents lack health insurance, and they fit the profile of the uninsured in the rest of the country. They are not homeless or unemployed, but mostly low income workers whose employers no longer provide health coverage, or self-employed individuals unable to afford the sky high premiums.

To deal with this problem, Montgomery County approved Montgomery Cares, a program devised and now administered by the Primary Care Coalition.

Primary Care Coalition is an independent nonprofit organization that has been working since 1993 as an advocacy group to increase access to primary and specialty health care by working through the Community HealthLink network of clinics. The Coalition receives financial support from many sources including the County and federal government, businesses, private foundations, social service organizations, and concerned citizens.

"In 2000, the county came to us and said, 'we have been giving money to all these clinics but can't know what quality of care they provide'," said Steve Seater, Primary Care Coalition's Director of Development. "So they decide they'll give us the money and we will handle all the clinics and make them responsible for the care they provide. They also wanted us to integrate all these clinics into one system."

Studies show that people without health insurance lead shorter, harsher lives. Furthermore, the uninsured also have a more difficult time returning to work after an illness due to lack of proper care and necessary medicines. About the only place they can get any care at all is at the emergency room of a hospital. But such care is inadequate for most because emergency medicine is not primary medical care.

Furthermore, some uninsured wait so long to obtain treatment that they must be hospitalized, which is very costly indeed. In 2000, the five Montgomery County hospitals lost some $53 million in uncompensated care.

"Latinos are the greatest beneficiaries of this service, since the Coalition is the only group in Maryland that provides free health care to the working uninsured, of which some 75% in Montgomery County are Latinos. The rest are Asian, West African, Haitian, and African American," explains Seater.

The Coalition devised an electronic patient record system that's one of the more advanced in the country. It links all the clinics into one system which allows for continuity of care, one of the biggest challenges of caring for the uninsured, since they go to several places to get care, most often to emergency services.

"You wouldn't have a primary care physician. The continuity of care will be there because of the patient's record," Seater explains. "We have managed to negotiate to eventually get the ER (emergency room) tied into the system; and we are even working to extend this to other clinics in the DC Metro area, for instance with Arlington, Virginia."

The program will not cover specialty medical care or vision and dental care. "To provide these services we must depend on the volunteer work of scores of doctors, nurses, diagnostic laboratories, optometrists, and lay people.
These doctors see patients referred by the clinics in their offices", said Seater.

Some of the clinics have paid staff, like Holy Cross Hospital which has a clinic; but others rely solely on volunteers, which is the case of Mercy Clinic. "We don't own the clinics; they have to raise their own funds."

To receive services in the clinics the main requirements are to be a resident of Montgomery County, and to have limited income.

"When you go to a clinic they will ask you a few questions to make sure you are receiving all the services you are entitled to. For instance, if you are out of work and have no assets you may qualify for Medicaid," explains Seater. "On the other hand, if you are employed, we will follow the federal poverty guidelines to determine eligibility."

Normally, undocumented immigrants are concerned about going to places where they may be asked about their immigration status, and that's one of the reasons they don't go to the doctor until the situation is an emergency. But Seater assures there is no reason for concern.

"The county has a policy of not discussing immigration status and we follow Montgomery County's policy."

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http://www.omhrc.gov/templates/content.aspx?ID=4950&lvl=2&lvlID=113

Isabel M. Estrada Portales is the OMHRC Director of Communications.
Comments? Email: iestrada@omhrc.gov