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HOME > ABOUT > PRESS > MIDDLE CLASS TESTS LIMITS OF LOCAL CLINICS
Article published - March 28, 2009
Credit: MARIN INDEPENDENT JOURNAL
Middle class tests limits of local clinics
by Richard Halstead
The free and low-cost clinics that make up Marin County's health care safety net are seeing a new kind of patient due to the economic crisis: recently unemployed members of the middle class.
"We're all beginning to deal with an economic situation that has never been experienced since the safety net was created," said John Shen, director of Marin Community Clinics, which provides care for a large percentage of Marin County's low-income and uninsured residents.
"What we're witnessing are people who are normally middle income falling toward the safety net," Shen said. "But they're not poor so they're not eligible for a lot of government programs."
Shen said newly laid-off people are showing up in larger numbers at the Marin Community Clinics' offices in Novato and Greenbrae. The patients tend to be 45 or older with chronic health conditions, he said.
The Rotacare clinic in San Rafael reports a similar shift in its patient mix since the economy tanked. The free clinic is operated by Rotacare Bay Area, a nonprofit organization based in Gilroy that operates nine clinics in Northern California.
"Before, we were seeing people who worked and just didn't have medical insurance, the underinsured or uninsured," said Marcia Amada, who recruits volunteers and raises money for the clinic. "Now we're seeing people who have lost their jobs and lost their insurance."
The number of people coming to the Rotacare clinic so far this year is up 10 percent from the same period in 2008, Amada said. The clinic, which is open 6 to 8:30 p.m. Mondays and Thursdays, regularly can't accommodate all the people who show up for same-day care. As a result, Rotacare's staff distributes numbers and holds a lottery to determine who gets seen. Five to 10 people are typically turned away each night. The clinic, which relies entirely on a volunteer medical staff, treated more than 1,600 people in 2008.
Diane Linn, executive director of the Ritter Center in San Rafael, said the health clinic that her nonprofit organization operates several days a week is seeing more patients who have recently lost health insurance that had been provided through COBRA, the federally legislated program that allows many laid-off employees to keep their existing insurance for up to 18 months if they pay for it themselves.
"They've burned through their savings and they can't afford COBRA anymore," Linn said.
Ritter Center, which provides services to the homeless, gets about 3,000 visits to its health clinic each year, Linn said. And she said, "There has been a pretty steady increase."
The Marin Community Clinics treated 1,400 new patients during the last four months of 2008 and the average number of people visiting the clinics each month has increased from 4,500 last year to 6,000 this year.
Shen said he isn't sure how much of that increase is due to the economy and how much is a result of the clinics' increased capacity. In June, the Marin Community Clinics opened a new 13,000-square-foot health center at 3110 Kerner Blvd. in San Rafael, which has 18 examination rooms. The agency had to decline 5,000 requests for patient care in 2006 because of a lack of capacity.
"That problem has gone away," Shen said.
The San Rafael clinic is now operating at full capacity with seven salaried physicians. Same- or next-day appointments are no longer a problem, Shen said. Early next month, the agency will relocate its Novato office from its 4,000-square-foot space at 400 Professional Center Drive to a 9,600-square-foot space at 6100 Redwood Blvd. The new Novato office will house eight additional examination rooms.
The Coastal Health Alliance, which operates low-cost clinics in Point Reyes, Bolinas and Stinson Beach, has not seen an increase in patients. About 6,000 people a year are treated at the Alliance's clinics.
"We're seeing people hold off on planned visits," said John Severson, the Alliance's executive director. "People don't want to make unnecessary expenditures because they've lost their job or they're worried about their job."
As a result, the people who do come in are sicker, Severson said. He expects the clinic's patient load to rise soon.
"There are signs that this recession is still building steam in West Marin and Marin as a whole," Severson said.
Shen said the Marin Community Clinics' financial model could be wrecked if more formerly middle-class people start seeking care there. In the past, about two-thirds of the clinics' patients had insurance of some kind. More than half of the clinics' patients were covered by Medi-Cal. Patients lacking insurance are charged using a sliding scale based solely on their income. People who are unemployed pay the minimum amount, $30, regardless of their assets.
"But we can't survive on that," Shen said.
Federal grant money that the Marin Community Clinics has received in the past may not be available to treat middle-class patients, Shen said.
"We can't spend a single dime in past federal grants on people who are above 200 percent of poverty level," Shen said. To meet that requirement, a four-person household can earn no more than $3,675 per month.
As part of the $787 billion stimulus package signed into law in February, both the Marin Community Clinics and the Coastal Health Alliance expect to receive money to help them meet increased demand for medical services over the next two years. The Marin Community Clinics, which has a yearly budget of about $10.5 million, will likely receive $291,000. The Alliance, which has an annual budget of about $3.3 million, is positioned to get $179,000.
Shen said he has no idea if this money will come with the same limits as past federal grants.
RESOURCES
Free and low-cost Marin County health clinics:
Marin Community Clinics
Cost: $30 minimum fee
To make a medical appointment at any clinic, call 448-1500
- Greenbrae, 250 Bon Air Road
- Novato, 400 Professional Center Drive, No. 424
- San Rafael, 3110 Kerner Blvd.
Coastal Health Alliance
Cost: $30 minimum fee
- Bolinas Community Health Center, 88 Mesa Road, Bolinas. For appointment and information, call 868-0124.
- Point Reyes Station Community Health Center, 3 Sixth St., Point Reyes Station. For appointment and information, call 663-8666.
- Stinson Beach Community Health Center, 3419 Highway 1, Stinson Beach. For appointment and information, call 868-9656.
Rotacare Bay Area
Cost: Free
- Kaiser Permanente, 1033 Third St., San Rafael. For information, call 479-8889
The Ritter Center Health Clinic
Cost: Free
- San Rafael, 16 Ritter St. For appointment and information, call 457-8182
Marin City Health and Wellness Center
Cost: $15 minimum fee
- Marin City, 630 Drake Ave. For appointment and information, call 339-8813
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