CNN's John King goes "outside the Beltway" for this look at health care in rural West Virginia. He speaks with a couple that has had their share of health problems, including the wife's legal blindness from diabetes. She (guess what) doesn't go for the periodic screenings that doctors say are crucial. "Because I can't pay for them," she said matter-of-factly. "And you know, I could go, and I'd get bills, and I can't pay those bills."
Shift to one of the doctors providing care at a community health clinic in the area, where nearly 30 percent of the population falls below the poverty line and at least 35 percent of the residents lack health insurance. Dr. Sarah Chouinard says, "We offer sliding fee payment scales. If they are at 100 percent federal poverty level or worse, they owe us $5 only, and the rest of their care is waived." The article continues:
Preventive care is the clinic's urgent focus, first and foremost, because it is good medicine. But also weighing on Chouinard and her colleagues is the knowledge that many, if not most, of their patients, because they can't afford it, won't follow advice to see a specialist if their health care needs are beyond the clinic's capabilities."Our hope is to keep people away from needing expensive health care services," she said.
Chouinard claims steady progress and credits a combination of growing trust in the community and aggressive clinic outreach using an electronic record database brought online with the help of federal grant money.
Now, she says, the computer alerts the clinic staff when a patient has skipped a follow-up appointment or failed to schedule a periodic screening. It can even alert doctors if, say, a patient who needs a certain asthma inhaler has not been in to get the prescription renewed.
"So we do a lot of this outreach to drive people back to the health center. ... Our role in a rural setting is key," Chouinard said. "The question is: How do we keep paying for it? How do we keep giving discounted care? How can we afford to keep the doors open?"
Make no mistake, Chouinard embraces the ideal of universal health care coverage. But as she follows the debate in Washington, she says she has not heard much, if anything, about how critical rural community health centers would be impacted.
"It will be interesting to see what happens if they come up with universal coverage," she said. "What will our role as a federally qualified health center be? ... How is our role defined after that?"
