As the U.S. Senate prepares to vote this week on sweeping health care reform, nearly 75,000 people are uninsured in Richmond, Columbia and Aiken counties, according to an estimate published earlier this year in The Augusta Chronicle . Those patients seek health care security and a way to better and affordable health that right now depends on indigent care, community clinics and volunteer doctors.
Mr. Salvesen, 55, had worked since he was 13, mostly as a pipe fitter, until his emphysema and chronic obstructive pulmonary disease made him so short of breath it affected his work.
"One day I was walking around incoherent," he said. "I didn't know where I was."
Since doctors told him he was unfit to work, however, he has waged an unsuccessful four-year battle to get disability coverage.
"I guess it is a system that is overwhelmed," Mr. Salvesen said. "They are always denying and denying until you're absolutely at your end."
He relies on indigent care through University Hospital and other care at the Miracle Making Ministries clinic on Druid Park Avenue.
"These clinics save this town," Mr. Salvesen said.
Instead of qualifying for it through disability, he likes the idea of being able to buy into Medicare at age 55.
"That would be a good deal for me," he said.
Unfortunately for Mr. Salvesen, Sen. Joe Lieberman, D-Conn., reportedly does not agree, and that part of the health reform will apparently be dropped to get his vote, crucial for the 60 that Senate Democrats need to get the bill past Republican filibusters.
Sen. Ben Nelson, of Nebraska, the last Democratic holdout, declared his support for the legislation Saturday, virtually guaranteeing a vote before Christmas Day.
Next to Mr. Salvesen at the community clinic is Thomas Evans, 46, who returned to Augusta about four months ago after getting laid off from his computer-services job in Atlanta. While looking for work since, he has also gone through hoops trying to qualify for indigent care at University Hospital and then find a doctor who can follow him for high blood pressure, among other things. For him, the useful end result of health care reform could be summed up in three words: "Network," he said. "Easier access."
As a computer technician, he is hoping federal efforts to require electronic medical records in a few years will improve his care, making it easier to move around, and provide a market for his skills.
"Electronic records management," he said. "That's what I do."
He imagines himself "dealing with the mom-and-pop clinics and hospitals," he said. "That when it does become mandatory, they don't have to go to these large companies like McKesson, Cerner, Cardinal Health and pay all of these high fees" to get a system installed.
He thinks health insurance is something that people ought to be able to buy into.
"For those who are disadvantaged it should be relatively free," he said. "Not totally free, but relatively."
That seems problematic to Melinda Rider, the executive director of the Neighborhood Improvement Project, which runs the Belle Terrace Health and Wellness Center and the Belle Terrace Downtown Health Center. She has seen the number of uninsured her clinics serve jump from 30 percent to more than 50 percent, with about 70 percent of those being served by the downtown clinic.
The clinics charge a sliding scale fee, and even that is tough for some patients, which makes Ms. Rider wonder how an individual mandate to purchase insurance would work.
"For those patients who are on the sliding-fee scale, insurance that they have to pay for isn't going to work," she said. "They can't pay for it."
Instead, she thinks officials should just acknowledge that health care is a necessity and do what is required to get patients care.
"There has to be a consensus that we need to provide care, and not we need to provide care as long as it doesn't cost us anything, because that's not going to happen," Ms. Rider said.
"We all know in the long run we are better off. We pay for it now or we wait and pay a whole lot more later, both in terms of direct cost but also in terms of just human suffering."
One aspect of health reform that appears likely to be part of any final bill is an end to denial of coverage for pre-existing conditions.
This pleases, Tamara Rajah, the CEO of Skip to My Lupus Inc. in Augusta, a group that seeks to connect lupus sufferers such as Mrs. Rajah with services and support. Her daughter Alison Sheppard also has lupus and, after searching for two years, was able to qualify for health insurance through her father only to get kicked off at the worst time.
"They dropped me while I was in the hospital," Ms. Sheppard said. "The reason was I went to the hospital too many times."
Being denied insurance is something Mrs. Rajah said she hears "maybe two or three times a week." And the consequences of going without care are severe for lupus patients, whose immune system mistakenly attacks different organ systems and can lead to kidney failure and heart attacks, she said.
"If they don't get ongoing treatment, they normally suffer a premature death," Mrs. Rajah said, "and a terrible one at that."
Even if it passes, much of the health reform bill does not kick in for years, which makes no sense to Terrence Cook. The Augusta allergist is the chairman of the board and president of Richmond County Medical Society Project Access, which coordinates volunteer hours and services from physicians with low-income, uninsured patients in Richmond and Columbia counties.
In the past year, the number of patients it serves has gone from about 235 to about 620, he said, even as the group has taken 10 percent and 15 percent cuts in funding. Instead of creating a whole new bureaucracy, as the bills envision, why not use the existing Medicaid for a temporary expansion to reach patients suffering without care, Dr. Cook said.
"One of the things you could do with that is you could begin to rescue people immediately and begin to solve some problems," Dr. Cook said. It would have to be a federal-only Medicaid expansion (Medicaid funding is normally split between the federal and state governments) and it would be made temporary so that once the economy recovers and more people are working the guidelines would go back to previous levels.
"What we're trying to do is maintain people with chronic illnesses, provide them with their medications, so they stay out of the emergency room and their disease process does not progress to the point where it becomes ever so much more expensive to care for them," Dr. Cook said.
To Mr. Salvesen, a working man who now misses work and all that came with it, health reform is just a matter of fairness and decency.
"Everybody needs health care," he said. "Money shouldn't matter."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
ARE YOU UNINSURED AND IN NEED OF ASSISTANCE?
While the U.S. Senate debates health reform, local organizations are taking care of the uninsured.
- Richmond County Medical Society Project Access, which serves the uninsured in Richmond and Columbia counties through a network of volunteer doctors and hospitals. Coverage is limited to those at or below 150 percent of the federal poverty level -- for instance, an annual income of $20,975 for a family of four. It is for patients ages 18 to 64 who have been a resident of Richmond County for at least six months or a resident of Columbia County for at least a year. Call (706) 733-5177.
- Belle Terrace Health and Wellness Center, 2467 Golden Camp Road, and the Belle Terrace Downtown Health Center, 818 St. Sebastian Way, Professional Office Building II, Suite 404A. Call (706) 790-4440. The centers charge low-income uninsured on a sliding scale.
- Miracle Making Ministries Druid Park Community Health Center, 1127 Druid Park Ave. Call (706) 738-0455.
-- Tom Corwin, staff writer
Key provisions of the Senate's health care legislation
* In place of a government-run insurance option, the estimated 30 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.
* Insurance companies would be barred immediately from denying coverage to children because of a pre-existing health condition. The prohibition on denial of coverage for adults would not take effect in the Senate bill until 2014, a disappointment for consumer advocates.
* Among the changes Senate Majority Leader Harry Reid incorporated was dropping a proposed tax on cosmetic surgical procedures, including Botox injections. Instead, Senate Democrats are proposing a 10 percent sales tax on tanning salons, to be paid by the person soaking up the rays. The Food and Drug Administration says ultraviolet radiation from tanning can increase the risk of skin cancer.
* The revised bill also calls for a 0.9 percent increase in the Medicare payroll tax on incomes exceeding $200,000 for individuals and $250,000 for couples. Mr. Reid's earlier bill had a smaller increase, 0.5 percent.
* The bill also taxes high-cost insurance plans as part of a plan to put downward pressure on health care use.
- Associated Press
With a critical health care vote looming this weekend, Senate Democrats reached a deal with the lone party holdout, Nebraska Sen. Ben Nelson. With Mr. Nelson backing the health care legislation, Democrats have the 60 votes they need to quash a series of Republican-led filibusters and pass the bill by Christmas.
What it took
Mr. Nelson agreed to support the bill only after Democratic leaders made changes that included placing limits on federal abortion funding. He reached the agreement in Senate Majority Leader Harry Reid's office Friday night after round-the-clock talks with Mr. Reid and Sen. Barbara Boxer, D-Calif., a leading supporter of abortion rights.
The compromise toughening abortion restrictions tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. It would also allow states to restrict coverage for abortion in new insurance marketplaces.
The deal with Mr. Nelson paved the way for Mr. Reid to introduce a long list of proposed changes to the legislation Saturday morning and then file a series of procedural motions that would allow the Senate to take a final vote on the bill on Christmas Eve.
That requires three procedural votes staggered between Monday morning and Wednesday afternoon, a tight timeline Democrats must adhere to if they are to pass a bill by their self-imposed deadline.
The Senate bill will have to be reconciled with health care legislation passed by the House in November. That process could drag on for months, although Democrats are hoping to finish work in January.
What it will mean
The $871 billion bill, expected to cut $132 billion from the deficit over the next 10 years, would require nearly everyone to obtain health insurance policies. By 2019, about 94 percent of eligible Americans are expected to have coverage, up from the current 83 percent, according to the nonpartisan Congressional Budget Office, which estimated 31 million more people younger than 65 would become insured, leaving about 23 million without coverage.
- Edited from wire reports