Covering the Uninsured
Covering the Uninsured
Caring for the uninsured is not a profitable business. If it was, more clinics would do it. But if this underserved patient base is ignored, beyond even the moral implications, it can cripple the medical economy. In Shelby County alone, 10 percent of the population is uninsured, as data reported in 2005. Equate that to the 2006 population of more than 900,000 and that’s 90,000 or more people without any form of healthcare coverage. Where do these people go for primary care? Unfortunately, many of them end up in the emergency room with chronic conditions. Thankfully, some Memphis clinics dedicate services to the underinsured and uninsured.

The Christ Community Clinics, Health Loop Clinics and the Memphis Health Centers provide primary and therapeutic care to residents of Shelby County, regardless of their ability to pay. These non-profit clinics are part of the Tennessee Primary Care Association (TPCA), an organization dedicated to community health centers in underserved urban and rural areas of Tennessee. Some of their clinics are federally qualified to receive grant funding and all depend on crucial state funding to maintain their ability to serve the uninsured. In 2006, about 34 percent of the patients seen in Community Health Centers in West Tennessee were uninsured, according to TPCA data.

Christ Community is a federally-qualified health center (FQHC) with four clinics in some of the most underserved areas in Memphis, including Frayser, Orange Mound, Binghampton and south Memphis. With 90,000 patient visits annually, about 30 to 35 percent are uninsured, 17 percent of which are children. Fees are issued on a sliding scale and patients are categorized based on reported income. The neediest have a $25 charge which includes the doctor’s visit, lab work and any available on-site testing.

“Our mission is to go to the places where people are having the hardest time getting primary healthcare,” said Dr. Rick Donlon, director of the Binghampton clinic, particularly for those “people who can’t afford the cost of health insurance and aren’t poor enough to qualify for government insurance.”

Many Christ Community patients utilize Medicaid services, some are still on TennCare and others are in the Cover TN program.
Added Donlon, “there’s a large group who get caught in the middle here.”

With thousands of people at or below poverty levels, Memphis has significant health inequality. If underserved patients continue to tax the ERs and go without primary care until their chronic health conditions become end stage diseases, the cost to the healthcare system will be enormous.

“The art of medicine is trying to develop these relationships and get some continuity going and that works a lot better in a clinic than in an emergency room,” Donlon said. “Every sector of the healthcare system has some sort of culpability in this.”

While these clinics do provide healthcare to the homeless as well, the majority of patients are the working poor. Unique to the various clinics serving the uninsured is the Church Health Center (CHC), whose patient base consists entirely of uninsured citizens.
Founded in 1987 by Dr. Scott Morris, a family practitioner and ordained United Methodist minister, his goal has been to provide quality, affordable healthcare for working, uninsured people and their families. Through financial support in the faith community and the volunteer assistance of doctors, nurses, dentists and other support staff, CHC has grown to become the largest faith-based clinic of its type in the country, something they work to replicate in other underserved urban areas across the country. CHC sees 36,000 patient visits annually and fees are also charged on a sliding scale based on income.

“We need to focus on how to keep workers healthy, which are the economic backbone of a city,” said Morris. “An unhealthy workforce equals an unhealthy city.”

A canon of CHC is putting a dollar into prevention for every dollar used to treat patients, which is made possible through their Hope and Healing wellness ministry, which offers personalized exercise plans, cooking classes and activities for children and teens.
The issue of providing healthcare to the underserved is complex, Morris explained, because it requires giving more than time. With more than 400 physicians volunteering their time as evidence, “I definitely believe every doctor in Memphis wants to help,” assured Morris.

“We have to keep working as aggressively as we can to do our fair share,” he added. “Make it what it means to do healthcare in Memphis.”

Clinics serving uninsured patients in Memphis and Shelby County
  • Christ Community Clinics – 90,000 annual patient visits, 30-35 percent uninsured.
  • Health Loop Clinics – 95,000 to 110,000 annual patient visits, 25 percent uninsured.
  • Memphis Health Center – 39,202 annual patient visits; 13,460 uninsured.
  • Church Health Center – 36,000 annual patient visits; 100 percent uninsured.

Uninsured in State and County
  • About 15 percent in the entire state are uninsured (2007 CDC data)
  • Approximately 600,000 Tennesseans are uninsured (2006 data – TN Department of Commerce and Insurance)
  • About 10 percent of Shelby County residents are uninsured (2005 data – Behavioral Risk Factor Surveillance Survey)
  • Approximately 118,000 people in Shelby County are uninsured (2005 data – Behavioral Risk Factor Surveillance Survey)

Household Surveys of Insured Individuals and Families:
  • Public insurance programs provide healthcare coverage for 44.4 percent of the insured population;
  • For remaining covered individuals and families, 54.6 percent of health insurance was provided by or purchased through an employer.
  • The elderly were more likely to be insured than any other age group through Medicare and retirement benefits from employer-based insurance health plans.
  • Of families and individuals surveyed in West Tennessee, 11.19 percent were uninsured.

Demographic Characteristics:
  • Adults between the ages of 41 and 65 accounted for 51.25 percent of the uninsured individuals and families sampled.
  • 58.4 percent of the uninsured individuals and families had family incomes less than $30,000.

Source: Aggregate data from Tennessee Primary Care Association

May 2008