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South Carolina’s best kept secret

According to Warner, CHCs have saved the national health care system between $9.9 and $17.6 million a year.

By Todd Morehead

A record number of Americans are without health insurance with the total topping out at well over 40 million, according to recent U.S. census numbers. South Carolina, for its part, has uninsured and unemployment rates that are higher than the national average, the populations overall health status is ranked 48th in the nation, according to some health policy analysts, and the state’s Medicaid system has been rated as one of the top 10 worst in the nation where benefits and cost of care is concerned. Yet, while South Carolinians are struggling within the country’s free enterprise health care system, others have discovered a viable, yet largely underreported alternative in the form of local community health centers (CHCs).

CHCs are essentially community-centered nonprofits that strategically position themselves in communities, both urban and rural, that are medically underserved. They provide comprehensive primary health care and dental services and are required to have a sliding fee scale for those with limited means and no insurance coverage. They also receive federal grant money to provide enough revenue to allow the centers to provide care to those with no means at all.

President Bush was as a proponent of CHCs during his governorship and has also advocated for it during his tenure in the Oval Office. In 2006, S.C. provided $1 million to help the CHC program expand its capacity due to the number of uninsured and the working uninsured in the state. This year the state appropriated $1.1 million. Locally, CHCs provided services to about 111,000 uninsured patients in S.C. in 2006. And unlike free clinics, which rely on volunteer providers, CHCs focus on long-term care rather than treatment of episodic events.

According to local trends between 2000 and 2005, more and more South Carolinians are seeking out community health centers. And not just because of rising insurance costs and higher unemployment rates.

“There is more information out now about community health centers and people are realizing the physicians, providers, nursing staff and others are just as good or better than providers you’re going to find anywhere else,” says Peter Leventis, with the S.C. Primary Health Care Association (SCPHCA).

But doesn’t providing free quality primary care sound dangerously close to, gasp, universal health care?

“From my perspective it’s closer to a managed care model,” says Leventis.

Universal care, he says, is a set system that is available to everybody regardless of their means and the funds and reimbursements for services are set. Managed care still places a lot of responsibility on the individual as well as the health care provider in order to be effective but doesn’t necessarily make everyone fit into one model. Because different managed care programs offer a variety of services with varying costs and reimbursements, Leventis says the managed care program “still has a bit of a market driven competitiveness to it versus a mandated universal health care plan.”

Recently, Gov. Sanford pushed for an overhaul of the states Medicaid program that would issue debit cards with preset spending amounts for recipients. Some in the CHC community worry that recipients with more extensive needs would need to shop around for a plan that would offer the best coverage. If a recipient isn’t health care savvy, they may run into significant problems. There also may not be sufficient orientation for recipients who are auto enrolled into the program.

“We’re concerned about ensuring quality and affordable services and are monitoring [Sanford’s new plan] carefully to make sure that it is going to work out for the best interests of health care recipients in South Carolina,” says Catherine Warner, a health policy analyst for SCPHCA.

As of 2006, S.C. requires stiffer documentation requirements to determine if a citizen is eligible for Medicaid. Newly eligible recipients must now provide documentation of both U.S. and state residency in the form of an original birth certificate, which could be extremely difficult for many. Some worry that the change places a roadblock in front of people who would otherwise be eligible for Medicaid. According to the SCPHCA, the number of enrollees has dropped because of the legislation.

“I mean, who has an original sealed copy of their birth certificate laying around?” Warner asks.

The U.S. health care system is also less than friendly to the many uninsured migrant workers who labor on American farms. Across the country, CHCs have drawn flak from some for using tax dollars toward health care for migrant workers who can’t provide proof of residence. Communities in S.C. –part of the “coastal stream” of migrant workers who work their way up the coast from Florida to New England—have mostly shown support for the programs.

Aside from general health care, S.C. CHCs also provide OB, delivery and prenatal services for expectant migrant mothers and have a pediatrics program for kids.

“It’s a really difficult population to provide services to,” says Warner. “But we contract with doctors in areas with high concentrations of migrant and seasonal farm workers who can give them the care that they need during non traditional hours with non traditional settings. They set up clinics in camps and have volunteers come in.”

Information provided by those doctors led the government to mandate for things like protective eyewear for workers and more favorable working conditions.

CHCs also decrease the use of emergency rooms for non-urgent care and instead provide preventative services and chronic disease management.

“South Carolina spent something like $2.65 million on non-urgent emergency room visits last year,” says Warner. “Look at that number and think about how there are close to 800,000 uninsured South Carolinians and one in four of those uninsured South Carolinians will go to the emergency room for something that could have been taken care of in another setting.”

“Plus,” adds Leventis, “if we can get to people early, we can reduce hospital stays, save the taxpayers money and make funds available for other services.”

According to Warner, CHCs have saved the national health care system between $9.9 and $17.6 million a year.

“Some people have to make a choice whether to fill a prescription or put food on the table,” says Leventis. “And usually they’ll choose to put food on the table for the family every time. And when a breadwinner’s health fails because of that and that person is removed from the family, now there is a whole family in need. So, we have to look at patients a little bit more holistically.”

Simply diagnosing and writing a prescription may not help the populations overall health in the long term. To combat that, CHCs determine the literacy of the patient to ensure that they truly understand their health care need and condition. They also try to discern whether the patient has a job, food, and a place to live to determine an approach that will have the greatest impact on the general scheme of their familial life. “We also work to connect them with other entities—civic, social, other non profits, food, clothing, etc—in the community, to help the patient get well all around and be more productive,” says Leventis.

S.C. CHCs currently operate a homeless health care program and also have a clinic that specializes in HIV/AIDS care. The state currently has 136 small community health clinics providing comprehensive primary health and, in some cases, dental care. There are 21 clinics in Richland County.

A complete list of regional centers and contact information is available online at http://scphca.org