Fight continues to improve health care for the working poor
Commentary by Bill Phelan
In the November referendum, 40 percent of us voted to tax ourselves a dollar a week to fund lifesaving health care for the uninsured of Leon County. More voters chose not to increase the sales tax, so the referendum to provide the working poor with insurance failed.
Months later, it is still true that people lacking health insurance are more likely to die before their time. Because they are less likely to get early care when their diseases are most treatable, women with breast cancer and people with colon cancer are 50 percent more likely to die from the disease if they have no health insurance. It is also true that parts of Leon County have rates of infant mortality that approach those of developing countries.
Ironically, it is also true that many voters and public officials, even those who voted against the sales tax for health care, are now choosing to fund a performing arts center with public funds - a sales tax on motels to fund a concert center for those with disposable income. Public funds for concerts, and not for health care!
It used to be said that in Leon County, a dot of blue in a state of red, we have a tradition of caring for our neighbors in need. Now, I'm not so sure of that.
So, now what? The problems are not going away. Neither is TEAM (Tallahassee Equality Action Ministry, a social justice organization of 20 local spiritual communities). And neither is the PHIAB - the Primary Healthcare Implementation Advisory Board.
The PHIAB is the board designated by Leon County to deal with the problem of health care for the uninsured. It is composed of the "stakeholders" - the CEOs of the two hospitals, representatives from the Capital Medical Society, Capital Health Plan, the Leon County Department of Public Services, FSU School of Medicine, Leon County Health Department, and the County Administrator (Parwez Alam), and an appointee from each Leon County commissioner. The PHIAB has in the past been most dysfunctional - unable to make decisions, or even to discuss the problem - due to obstruction by some of the political appointees, especially those of commissioners Tony Grippa and Ed DePuy. Commissioner Bryan Desloge has replaced Grippa's man with a business person, Steve Evans, who seems interested in discussing the issue, at least. And Commissioner DePuy's appointee hasn't been attending many meetings.
In what I see as a hopeful move, at the first meeting of the reconstituted PHIAB, Dr James Stockwell of Capital Medical Society was elected chair and Art Cooper, a retired healthcare administrator, was named vice chair. They are serious people who care about the issue and have a good track record of proposing and supporting solutions.
The PHIAB is discussing what their role will be, now that the MSTU (property tax for health care) has been eliminated in the county budget for 2007. They are reviewing the functioning and effectiveness of the two clinics - Bond and Neighborhood Health Services - with an eye, I think, to making them more effective. They may take on the issue of infant mortality as well. They have the responsibility of advising the Board of County Commissioners on health care solutions.
So what is TEAM doing?
Since before November, Rabbi Jack Romberg, TEAM's co-president, has been meeting with community leaders and public officials to try to reach consensus on improving health care for our area's uninsured. There are several different suggestions offered, including extending and expanding current health care plans.
TEAM members are in research mode - meeting with the Bond and neighborhood clinics, with county commissioners and staff, with the PHIAB, and with health care providers to develop ways of expanding the current CareNet system of health care for the uninsured.
So far it is clear that:
1. The Bond Clinic and Neighborhood Health Services need expanded or different space if they are to operate efficiently and take on more patients. Both clinics need to employ more providers (volunteer and funded) in primary care and in mental health care, but cannot do so because of inadequate space. The owners of both buildings (FAMU and Tallahassee City) charge rent that impedes the clinics' effectiveness.
2. There is a dire need for outpatient mental health care for uninsured patients. Currently, the only sources for mental health care for low income people without insurance are: the Apalachee Center (for inpatient, involuntary care); and the Neighborhood Health Services Clinic (for outpatient care.) Last time I checked, NHS had an 18- month waiting list for their mental health services because they relied on a volunteer psychiatrist one day a week. Mental illness, as we know, can be fatal.
3. There are some state and federal programs that are under-utilized by low income, uninsured patients. Under-utilization of KidCare, Healthy Start and other prenatal care programs may be a factor in the high infant mortality rates of Leon, Gadsden and Jefferson Counties. The reasons for under-utilization need to be studied and possible solutions proposed.
As we continue our research, TEAM is well aware that the climate is not right for a half-cent sales tax at this time - although in future years, this may change. We are working for changes on a smaller scale, and we continue working with the PHIAB and other interested parties.
We are also aware that there is talk of universal health care on the federal level, and that some states (such as California and Massachusetts) are requiring health insurance for all residents and are instituting public subsidies for those who cannot purchase insurance on their own. We know that some in Florida's government are also talking of such mandatory insurance. We are encouraging our governmental representatives to support these movements.
Health care for the uninsured is an ongoing issue for TEAM and for the PHIAB. We're not going away from it, because the issue is not going away.
Bill Phelan co-chairs the Tallahassee Equality Action Ministry (TEAM) Health Care Issue Committee.
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