At Garden City Community Clinic, we treat people who fall in “the gap.” The gap is people who don’t have employer-sponsored health coverage, can’t afford or don’t qualify for coverage under the Affordable Care Act, and don’t qualify for Medicaid. The gap is where people live who have a temporary financial setback in their lives, are employed but not enough to afford health care, or are facing some other difficult situation. I have been in the gap, perhaps you have been there, or you know someone who has been there. Most of those in the gap are looking for a hand-up, not a handout.
People in the gap have medical issues, but their overall health and well-being is influenced by many other factors. The County Health Rankings Model ranks the main factors that affect health and well-being — how long and how well a person lives. Social and economic factors such as education, employment, relationships and income have the greatest impact at 40 percent. Health behaviors such as smoking, diet and exercise account for 30 percent, clinical care for only 20 percent, and the final 10 percent is the physical environment.
Our legislators are working to improve health and well-being for people in the gap by introducing various bills to our state. Recently, they decided not to support Gov. Butch Otter’s Primary Care Access Program, which offered more limited clinical care than a Medicaid redesign (It would have covered only basic primary care and no secondary needs such as medications, specialty care, surgery, or hospitalizations.) I am thankful our state is trying to devise a plan for health care that is comprehensive. Unfortunately, all legislation proposed thus far focuses little on ways to concretely address the majority of underlying problems that affect health and well-being.
To treat the whole person requires more than just a medical clinic or a primary care team. As director of the Garden City Community Clinic (a project of Genesis Community Health), we provide a broader, more holistic approach. We provide medical, dental and mental health care for those in the gap and beyond. But we also help people address the other factors that affect their health and well-being.
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Through our Community Connector program, we connect them to social, economic, health-behavior and physical-environment resources such as job training, housing, food, gym passes, child care and so much more. In addition, we facilitate a collaborative effort of over 20 different organizations representing all the impact areas — health behaviors, social and economic, clinical care, and physical environment. Our objective is to improve health and well-being together as a community, rather than working in the silo of clinical care.
As the debate rages on in our state over how to help Idaho citizens who are in the gap, we hope legislators realize that clinical care addresses only 20 percent of the factors that influence health and well-being. Our communities need clinical care access and quality to be addressed, but even more, need innovative plans that address all the factors impacting health and well-being.
Josh Campbell is a master of public health graduate from Idaho State University and currently director of the Garden City Community Clinic (a program of Genesis Community Health).