It was a sunny Saturday morning, but Anna Ruttenbur was indoors, in the waiting room of Vineyard Christian Fellowship’s medical clinic. Ruttenbur, like about 78,000 people in Idaho, doesn’t have health insurance and doesn’t qualify for state or federal assistance. The 37-year-old Garden City resident falls into the “Medicaid gap.” But she needed a prescription.
She had heard about the church’s clinic from a “self-rescue” booklet and had visited once before. Ruttenbur liked that experience “better than any doctor I’ve paid to see,” she said.
Vineyard’s clinic is a compact, tidy office in Garden City that most people will never see. No billboards flank the freeway to let you know it’s there. No glossy fliers will arrive in your mailbox, inviting you to take a tour. The only people who visit the walk-in clinic are those who go searching for it — one of few options the poor and uninsured have for health care outside of an emergency room.
There are four clinics like it in the Treasure Valley, serving the poorest of the poor. They operate in concert with Idaho State University-Meridian’s free community health screening program, which spots troublesome health issues and refers participants to free and low-cost clinics.
“One of the real reasons I think that all (the) clinics were formed is to help prevent people from going into the ER,” said Marie Blanchard, a retired registered nurse who started Friendship Clinic on the Boise Bench about 10 years ago.
These health care providers don’t charge. There is no sliding scale, no $25 co-pay. The clinics complement their sliding-scale and low-fee brethren, such as Family Medicine Residency of Idaho and Terry Reilly Health Services.
Patients often show up with diabetes, high blood pressure, mental illnesses and other chronic problems that, if left untreated, could kill or bankrupt them.
HELP WHERE THERE’S NONE
Free clinics are a safety net that will have to catch Idaho’s poorest residents for at least another year. That’s because Idaho lawmakers balked at taking up a bill this year to provide Medicaid coverage to Idaho’s working poor — a crucial step in getting them access to the kind of preventive health care the Affordable Care Act was designed to provide.
What’s more, the rising cost of health care is making even insured Idahoans seek out free clinics. Under the Affordable Care Act, insurance policies sold on Idaho’s exchange must cover some preventive care such as Pap smears and colonoscopies, at no cost to the patient. But patients have to chip in or pay the whole bill for most anything else.
“We have plenty of patients who come and they got insurance initially, because they could afford insurance. But they can’t afford the deductible,” said Genesis World Mission’s Domestic Operations Director Josh Campbell, who oversees the Garden City clinic.
The Genesis clinic must turn away those patients, he said, because it doesn’t serve people who have insurance. Even with such narrow eligibility criteria — no insurance, income up to 200 percent of the poverty line — the clinic’s 30 volunteer providers see about 600 people a year, for an average of three visits per person. The clinic is booked a month out for medical care, two months for dental.
When someone finds out they’re ineligible because they have insurance — skimpy though it may be — they sometimes decide to drop their insurance coverage, Campbell said. They decide it’s more affordable to do that and return to the free clinic than to fork out $5,000 a year toward a deductible, he said.
It’s a pattern the other clinics are seeing, too. And it’s causing them to re-evaluate who they accept.
The Vineyard clinic used to ask about insurance. Now it takes all comers, said Elen Hunt, one of the clinic’s administrators.
“I stopped asking the question,” she said. “If you’re here, you need to be here.”
MORE DEMAND THAN SUPPLY
The Canyon County Community Clinic, a Christian nonprofit founded in 2010, takes anyone whose income is up to 200 percent of the poverty line — $11,770 for a single person and $24,250 for a family of four . In the past five years, the clinic has logged more than 2,700 appointments, all on Wednesdays.
“There are patients we turn away each week because we have a full docket,” said Executive Director Tom Bowman.
The organization also gets occasional calls from low-income Idahoans with high-deductible insurance. “What am I supposed to do?” they ask.
“We are talking with our board about where do we go in the days ahead, with our population that is underinsured,” Bowman said.
The clinics partner with other organizations —for example, the West Valley Medical Center in Caldwell does lab work for the Canyon County Community Clinic — but their resources are finite.
Still, they set aside time for people who go through the ISU-Meridian free screenings. And those screenings often are the first time Treasure Valley residents learn that money doesn’t have to stand in the way of getting a checkup.
CATCHING PROBLEMS EARLY
Boise couple Olbin and Elmira Yanez hired a baby-sitter to watch their four children and made a special trip last month to ISU-Meridian’s last screening of the spring semester.
Olbin Yanez, 34, hadn’t seen a doctor in 10 years. He doesn’t have health insurance and he never got sick, so he didn’t see the point.
But Elmira Yanez got a flier about the screenings while she was enrolling her second-youngest in kindergarten. She goes to the doctor but knew Olbin was concerned about his blood sugar and possible diabetes.
Both adults spent about an hour at ISU-Meridian, winding through the maze of overall wellness screenings that all participants travel: dental, traumatic brain injury, blood pressure, hearing and vision checks; instant HIV and hepatitis C tests; blood-sugar and cholesterol checks; depression and alcohol screenings and free flu shots. ISU-Meridian provided the screenings with support from Ada County and staffing from local clinicians and students.
About 130 people attended screenings in the 2013-14 school year. Nearly all lacked health insurance, and the average participant hadn’t seen a primary-care provider or a dentist for about four years. As a result, four of every five participants had dental issues when they arrived. About 43 percent had medical issues, 37 percent needed counseling and many had problems with vision, hearing and nutrition. Screeners found high blood pressure in more than half of the people and possible diabetes in 41 percent.
“If we identify a need, and they’re interested in getting an appointment in the next month,” then a screening staffer will make a referral, said Glenda Carr, screening co-organizer and clinical assistant professor in pharmacy at the school. About 60 percent of patients follow through on those referrals, she said.
“We have made efforts in the past to find out why (the other 40 percent are) not going, and a lot of it is they don’t have money or they don’t have transportation to the facility,” Carr said.
What happens if the patient needs ongoing care and is poor and uninsured?
“That is the great question,” she said. “It’s tough.”
Olbin learned his blood sugar is fine, but his eyesight isn’t great. And he needs to have a primary-care provider. So the screening volunteers made him an appointment at a Family Medicine Residency of Idaho’s clinic, where he could get low-cost care.
That clinic is where Jessica Nolazco, a 23-year-old expectant mother from Meridian, heard of the free screenings.
Unlike most low-income, pregnant women in Idaho, Nolazco doesn’t have Medicaid, because of her immigration status. She has lived in the U.S. since she was 5 years old but still doesn’t qualify for public assistance, she said. With her mother’s help, she goes to the Family Medicine Residency clinic for checkups.
The screening intrigued her, and she brought along her mother, stepfather and son.
“I’m pretty healthy,” Nolazco said at the end.
One exception: Her blood sugar is too high, which can spell trouble when you’re pregnant. She is seven months along.
Nolazco’s last stop on the free-screening journey was a booth where a volunteer passed out healthy recipes and answered questions about nutrition.
Armed with the knowledge that she could give her baby a healthier start by changing how she eats, Nolazco lingered at the booth.
“I have a sweet tooth,” she said later, through a bashful smile.