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Among the many questions in the health care debate is how much should the government do to care for those who don’t have the money or insurance to get care themselves. Traditionally state governments have that responsibility, but in Texas, each county must pick up the tab for those costs not covered by other programs. Texas Public Radio’s Terry Gildea looks at a program in Bexar County trying to meet the healthcare needs of the working poor.
October 8, 2009 · A line has formed in the lobby of University Hospital in downtown San Antonio. People wait outside a room with a sign above the counter that says "CareLink." Inside one of the nondescript cubicles Herlinda Sanchez talks with Michelle Wilkerson about what she needs to qualify for the healthcare assistance program.
Wilkerson is a mother of four children who works part-time as a care giver. Her husband works too, but their employers don’t provide health insurance.
“I couldn’t really afford the healthcare with the four kids, and with his employment, it was too high. So I ended up having to apply for CareLink when I got sick,” said Wilkerson.
More than a year ago, Wilkerson was diagnosed with a neuro-muscular disorder. Faced with enormous medical bills she and her family had no way of paying, she enrolled in CareLink. Wilkerson is part of a growing number of people in Bexar County and Texas trying to get better with few financial resources. Dr. Gary McWilliams oversees Bexar County’s CareLink Program through the University Health System.
“They’re uninsured. Almost all of them are working. A lot of them have two jobs. They work very hard, but they don’t have the health insurance, but yet they have the healthcare need,” said McWilliams.
CareLink is not insurance, but it allows participants access to the medical services and prescription drugs they need while charging them a monthly fee they can afford to pay based on their income. It also puts a tremendous focus on preventative care by requiring routine physical exams to cut down on unnecessary visits to the emergency room.
“We took the CareLink members, and we assigned them to a primary care physician, and we said when you get sick don’t come to the emergency room, you’ve got a doctor now, you go visit with your doctor. Somewhere between 95 and 98 percent of our members now have a primary care doctor,” said McWilliams.
Having that physician helps keep some CareLink patients from getting sicker and costing the program more.
Bill is fifty and recovering from a series of open heart surgeries he had three years ago. He asked that his real name not be used for privacy reasons. During his visits, doctors discovered several skin cancer lesions that were removed before spreading and the follow-up care has given Bill the chance to get better.
“If I didn’t have CareLink, I would be seeing the cardiologist. I would not have the benefits of the various drugs which are keeping my heart running right now, that are keeping my cholesterol down to a good limit, that are keeping me from having to have surgery again,” said Bill.
Before Bill got sick, he was self-employed and uninsured. He spent his savings training to begin a new career that would provide him with some retirement benefits and health insurance, but he got sick before he achieved that goal. With CareLink he pays only thirty-five dollars a month for his medical services, on top of small co-pays for prescription drugs. The arrangement allows him to work toward the goal of finding a full-time job once he recovers and move out of CareLink.
“I am a person that in many ways is on the brink, but at least part of my problems are not worrying constantly about healthcare,” said Bill.
CareLink only covers Bexar County residents. Those who live outside the county are not covered and no one who moves to the county for health reasons can access the program. It’s designed to help those making 200 percent of the poverty level or less, roughly less forty thoudsand dollars a year for a family of four, who have no access to insurance, can’t get it and don’t qualify for any other programs. George Hernandez is the President and CEO of University Health system in San Antonio.
“CareLink again is the safety net that’s there to cover you in those sorts of situations. It is not insurance, but pre-existing conditions really don’t make a difference. What we want to do is we want to provide the healthcare in an economical and efficient way that gets the right outcome for the lowest cost,” said Hernandez.
CareLink continues to cost taxpayers money, but it’s less than what the bill would be if it didn’t exist. Before the program was conceived in 1997, the county collected only about a million dollars annually from uninsured paying out of pocket for services. Dr. Mc Williams says CareLink pulled in roughly 18 million dollars last year in monthly fees and drug co-pays.
“We save the taxpayers of Bexar County about 15 million dollars every year through this program. We get a benefit to cost ratio of 20 to 1. There’s almost nothing else that I can think of in medicine where you spend one dollar and you get back 20 dollars worth of benefits,” said Dr. McWilliams.
“CareLink saves money by partnering with University Health System and pharmaceutical companies and negotiating for lowest price on services. But as numbers grow, keeping costs down becomes more of a challenge. George Hernandez says CareLink enrollment is rising on average of 500 members every year and attributes that to the lack of affordable insurance.
“The recent articles that I’ve seen peg healthcare insurance for a family somewhere in the neighborhood of twelve thousand to fourteen thousand dollars a year. That’s a lot of money when the average family income in San Antonio is thirty-eight thousand,” said Hernandez.
Hernandez and McWilliams concede CareLink isn’t a perfect solution. The program is looking at a five million dollar budget shortfall this year, but it continues to help those most in need and give them a chance to someday lead healthier lives. |
