Iowans who rely on government health care programs often turn to free clinics for basic care when they fall through the system’s cracks.
Elizabeth Busler, 35, works odd jobs when she can and needs five insulin shots daily to control her diabetes.
She found help as a recent enrollee in IowaCare — the state’s health care program for adults with limited income who are ineligible for Medicaid — but even before she moved to Cedar Rapids last week, traveled from Vinton for medications at the Community Health Free Clinic.
“I get spells when it’s too high or too low,” she said of her blood sugar levels, adding that without her injections, “I could go into a diabetic coma or it could be fatal.”
Busler drove nearly 80 miles round-trip to the free clinic every three months because IowaCare doesn’t cover the cost of the shots, she said.
IowaCare has more limitations — on medications and mental health, for example — than Medicaid, which covers low-income people who are blind, disabled or pregnant, as well as certain children or a parent with a child under age 18.
Busler doesn’t have to look far to see the differences. Her boyfriend, Robert Purvine, 40, of Cedar Rapids, is disabled due to schizophrenia and has Medicaid coverage.
Medicaid covers the weekly injection for his condition, which, Purvine said, would be unaffordable for him at $937 each, but is less expensive than the alternative.
“Without it, I’d be hospitalized and the state would be paying for that,” he said.
Gov. Terry Branstad has indicated he opposes expanding Medicaid to more Iowans because he doesn’t think the federal government can afford it, but experts say patients are more likely to get preventive care for chronic conditions if they have health coverage.
The state already faces a quandary with IowaCare, since the program is scheduled to expire at the end of 2013.
“That will be one of the major pieces of action that the Legislature will have to address,” said Roger Munns, spokesman for the Iowa Department of Human Services, which oversees both programs.
Munns noted that the intent was to shift those nearly 60,000 IowaCare patients to Medicaid had that program expanded.
IowaCare was never intended to provide the same broad coverage as Medicaid, he added.
Just this year, more federally qualified community health centers were added so IowaCare patients would not have to travel to Broadlawns in Des Moines or University of Iowa Hospitals and Clinics in Iowa City for their care, as previously was the case.
One noticeable omission was Linn Community Care, 1201 Third Ave. SE, one of 14 such centers in Iowa that are partially federally funded. Munns said clinics were added in areas of the state where members had the least access to health care.
Linn Community Care sees about 2,700 patients per month, both insured and uninsured, on a sliding fee scale, but Linn County IowaCare patients must be seen in Iowa City.
“That is a big barrier to people in this area because of logistics and transportation,” Linn Community Care executive director Tim Olson said. “That becomes a real issue.”
“It’s hard to take a day off work for a sinus infection,” said His Hands executive director Sharon Patten, citing the transportation scheduling and daylong trip involved for IowaCare patients going to Iowa City. “Here, they walk in and they’re seen.”
His Hands prefers patients schedule appointments, but tries to accommodate walk-ins at the clinic at 400 12th St. SE.
Patients who cannot find care for simple problems often turn to hospital emergency rooms, a much costlier alternative, Patten noted.
His Hands’ new dental service has more than 500 people on its waiting list; a five- to six-month wait.
Dental care and mental health remain concerns in Iowa, said both Patten and Darlene Schmidt, executive director of the Community Health Free Clinic.
“Both of those are huge unmet needs,” Schmidt said, noting the clinic, at 947 14th Ave. SE, will evaluate anyone who walks through the doors. “We’re that safety net; that Band-Aid.”
Schmidt said patients in need of psychiatric care are referred to the Abbe Center.
The Community Health Free Clinic has a dental clinic, which, like His Hands, also has a lengthy waiting list.
Patients in need of specialty care, such as knee surgery, are referred to Linn County Project Access.
The program has provided free specialty care to 528 patients since its inception in 2008, said Deanna Derlein of Linn Community Care, which oversees Project Access.
Only certain low-income, uninsured patients are eligible. Doctors do not receive financial compensation.
Area specialists remain committed to the program to serve those in need, said Dr. James Levett, chief medical officer of Physicians’ Clinic of Iowa.
Levett, a Project Access volunteer, said he doesn’t see the needs of the uninsured being ignored in the Cedar Rapids area.
He also leads the Cedar Rapids Healthcare Alliance, a non-profit formed in 2005, initially to establish a community anticoagulation therapy clinic to serve patients on blood thinners.
Overseen by a nine-member board of directors, the alliance has a mailing list of about 500 people involved in health care.
Levett said the group’s mission is to identify and resolve health care and patient safety issues through community partnerships.
“The intention is not to deliver health care,” he said. “It’s to provide a forum where people can talk about health care issues. You can’t talk about health care reform without talking about the uninsured.”
Andrea Keil, 43, of Cedar Rapids, understands the issues firsthand.
“If it weren’t for the free clinics, I don’t know where I’d be,” said Keil, who is covered under IowaCare and suffers from a number of health issues, including diabetes and panic disorder.
When she makes it to Iowa City, the doctor can only see her for a limited number of minutes.
“The nurses say, ‘what’s your chief complaint?’ ” she said. “The doctor won’t see you for more than one thing.”
Keil had to go to a Cedar Rapids emergency room when she was having a panic attack that she though was a heart attack because she didn’t think she would make it to Iowa City. With her IowaCare coverage, she cannot be seen at a Cedar Rapids doctor’s office.
She doesn’t qualify for Medicaid because she doesn’t have children or other qualifications, she said.
Keil has seen a chiropractor and has received other help at the Cedar Rapids free clinics.
“You just don’t have to jump through the hoops,” she said of the clinics. “I don’t know what I’d do without them.”