Heart Health Month: An Acute Concern for the Uninsured and Underinsured

A Special Type of Health Care in MetroWest Seeks to Intervene before Unadressed Heart Conditions Can Kill

By Angela Crocker
Interim Executive Director, The Parmenter Foundation

On a recent Tuesday night clinic at Congregation Beth El in Sudbury, a MetroWest Free Medical Program physician staged a critical intervention that likely saved a life: a patient suffering from diabetes, uninsured and unable to afford their insulin prescription, was showing signs of a heart infection – a common complication for untreated diabetes.

Undetected, a heart infection can lead to a fatal heart attack. Any physician would know to look for these types of complications from diabetes in patients — at least those who are fortunate to enjoy health care insurance and a primary care physician who can track their health over time. But in the uninsured and underinsured populations, health care professionals need a careful sensitivity to identify underlying ailments that may have gone untreated due to a patient’s inability to afford care.

“This patient had gone without insulin for four to six weeks,” said Rick Iacobucci, who was named Executive Director of the MetroWest Free Medical Program in December. “Fortunately for him, his one interaction with a doctor in a long time was with a cardiologist specially trained to work with underinsured and uninsured patients to identify untreated conditions and complications.”

The potentially life-saving intervention’s cost to the patient? Nothing. An interpreter – also specially trained to understand health care terminology — was also on hand to provide translation from the patient’s native Portuguese to the doctor.

February was Heart Health Month across the United States. It is a time for agencies like the Centers for Disease Control to remind all of us of the risk factors for heart ailments like hypertension, high cholesterol and heart disease. Reducing salt in the diet, getting regular blood pressure check-ups, and exercising more can reinforce a healthy heart in all of us.

But for The Parmenter Foundation in Wayland, it is a time to shine the spotlight on its grant recipient program doing the critical work of health care for the most vulnerable patients in our community – not necessarily because their health conditions are the gravest, but because their untreated conditions can lead to complications that can become acute – and even fatal – over time.

A volume of research documents not only the uninsured and underinsured population in the United States, but the adverse health and financial outcomes due to their predicaments.

First, while the Patient Protection and Affordable Care Act of 2010 (ACA) significantly reduced America’s nonelderly uninsured population, the number of uninsured people in this 18-64 age group has been increasing since 2016. 27.9 million nonelderly individuals lacked health insurance in 2018, according to the Kaiser Family Foundation.

Worse, while individual mandates in both the Commonwealth of Massachusetts and the ACA have driven down the number of uninsured nonelderly individuals, the cost of health insurance has driven up the number of underinsured in the United States. Roughly 45 percent of Americans lack adequate health insurance – no difference than pre-ACA levels – as defined and studied by the Commonwealth Fund’s biennial health insurance survey in 2018. The law may require people to have health insurance, but since 2010, there is no difference in the number of people in the United States who still cannot afford the amount of health insurance they need.

Both subgroups – the uninsured and underinsured – put off some routine care due to a lack of coverage, according to data in both surveys. And when these two subgroups do seek out medical care, they have greater rates of financial hardship in paying their bills. This starts with a lack of coverage, but continues through the billing process, as doctors and hospitals frequently charge higher rates to those lacking coverage.

To stem this wave of medical and financial hardship, The Parmenter Foundation supports the MetroWest Free Medical Program with grants and other support to continue its weekly mission to provide a suite of free health care services to Metrowest residents.

Attendance at the clinic since its founding reflects the national research. The program began in 2004 treating around 25 clients at their walk-in clinic each Tuesday at Beth El in Sudbury. It now averages about 90 clients per week, who are offered a range of physician specialties from cardiology to the recent addition of psychiatry.

“We all wish we only had to go to the doctor once and never have to go back again,” Iacobucci said. “The sooner our clients understand that’s not the case – and that they can access free care – the better the quality of the treatment they’ll get.”

This regular treatment can keep common ailments – hypertension being the most diagnosed in the program – at a treatable level that does not lead to more serious complications. The program also provides educational material in three languages to inform clients about symptoms and risk factors that should lead them to a doctor before they become acute conditions. Clients can also get assistance with their prescription drugs.

This is another phenomenon where nationwide research demonstrates how deferring medical treatment due to a lack of insurance can aggravate medical conditions from routine to acute concerns.

In the nonelderly uninsured population, according to the Kaiser Family Foundation:

  • 52 percent have no usual source of care
  • 27 percent postponed seeking care due to cost
  • 21 percent went without needed care due to cost
  • 19 percent postponed or did not get needed prescription drugs due to cost.

The Commonwealth Fund’s biennial survey brings heart health specifically into focus. The uninsured and underinsured – including those who suffered from a “coverage gap” in part of 2018 are slightly less likely to have a regular source of care and have their blood pressure checked. This group is significantly less likely to have their cholesterol checked.

That’s why “pulling through” clients into regular and preventive care is a primary concern; MetroWest Free Medical Program backs up the effort with data tracking, a particular concern for a population for which no – or very little – documented health history may exist.

“Uninsured and underinsured people – as well as people on fixed incomes who cannot afford their prescriptions – are rolling the dice, putting themselves at risk of potentially fatal conditions,” Iacobucci said. “None of us will go through the rest of our lives without being sick. It’s critical for our clients to know they always have a place to see a doctor and feel safe doing so.”

No effort could be more reflective of the mission of Heart Health Month.

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