Flora Partin, a former cabdriver and foodservice worker in Tullahoma, says she loves to work, but when her undiagnosed pre-diabetes started causing her to blackout, she knew she needed help.
One problem that she faced was obtaining quality healthcare without insurance.
That’s where Partners for Healing, a free clinic for the working uninsured, stepped in.
“I got real, real sick…where I was blacking out while I was driving. But where I worked, they did not offer insurance.
The staff at Partners helped Partin get her blood sugar under control and helped make some long-term heath changes.
Partin recently started working for Waffle House in Tullahoma. At the time of her blackouts, she was driving a cab.
The taxi company didn’t provide insurance, and like many in Partin’s income bracket, insurance that is available under the Affordable Care Act mandate is too expensive.
Partin said that wait staff pay is $2.13 an hour plus tips.
Her dependable paycheck is about $40 a week after taxes. But her tips vary greatly.
“The problem is some week’s you barely make $50 a week in tips.
“Around the third of the month you do really well on tips. The middle of the month they slack off – the end of the month you make maybe $20.”
The company insurance is $75 per month.
“If they take money out of that for my insurance, I’m not going to have money to live on. I’m not going to find a place to live for $40 a week.”
Being a new employee, Partin is not yet eligible for insurance. She is training for a cook position that offers a reliable $7.25 per hour.
“[Partners] has even helped me get my teeth pulled. That is wonderful because I stayed sick with them,” Partin said.
“I love working; I can’t sit still; that’s just me. If I’m setting still, it’s because I’m sick or dead tired,” Partin said.
Part of Partin’s care was the diabetic disease management program that is designed to teach patients to increase their ability to self-manage their disease, allowing them to decrease the number of acute illnesses and complications.
After a few years in business, the Partners staff noticed several underlying causes that keep bringing patients in. The result was a more comprehensive treatment package that focuses on the cause and not the symptoms.
Belle Ruyten, a registered nurse and Partners’ Clinical Resources and Outreach Coordinator, said that most medical practices aren’t able to routinely offer the level of one-on-one health advice that the staff at Partners is able to provide.
It’s the difference between telling someone what to fix and showing him how to make the changes in his life that will stick.
“Health literacy is not a high thing [with people coming in],” Ruyten said. “They’re going from hand to mouth and don’t have extra time to go surf and read this and look up that. They’re just trying to survive.”
She said that several grants and cooperation with partners like the state Health Department and city departments of recreation are helping to change that.
“The reason [the diabetic programs] have done so well is [the staff] took time and would sit down with the diabetic patients one-on-one. They sit down 30 minutes at a time and make sure they understand the basics, every week or every other week, until they make sure [the patients] get it.”
Partners board president Jim Henry agrees, “Most doctor offices can’t spend that much time with a patient. They can treat them and give them what they need, but would have to move on to the next patient.”
He said he views changing lifestyles as the ultimate success.
“You’re not just treating; you’ve prevented. And possibly helped a generation into the future.”
Partners, still relevant even with universal
While an estimated 7 million Americans are newly insured, a surprising number of people are still without adequate health insurance coverage.
“[Our] program started with words and not numbers,” says Henry. “It stared with a goal to fill what was perceived as a gap in the healthcare system.”
With only a few months under their belts after ACA has begun in earnest, Partners leadership found that the numbers have dipped slightly, but they’re confident that is due to normal fluctuations in patient load.
“It’s difficult to know with just three months under our belt and the deadline for compliance just past two or three weeks ago, how it’s affecting us and whether there is a cause and effect between the numbers we’re seeing and that single item,” he said.
Henry added that ACA did not make insurance available for everybody.
“Our target market sill has a need. It is uncertain to what extent that is going to be affected. It’s just too new.”
Partners board member Ken Stewart, who was present from the beginning at Partners explained the idea from the onset, “We had a bimodal kind of community when it came to healthcare: Those who were elderly and indigent who qualified for Medicaid and Medicare, and then you have the those who were employed … at a level where they could afford the commercial plans that were available to them.”
The valley between the two, as he describes it, consists of working insured, people who either weren’t offered or couldn’t afford insurance.
“The ACA seemed to approach the same sort of issue, just on a larger systemic result, to [create] one that was available on all levels”.
He describes it as building a bridge from both sides. But the problem is that the bridge doesn’t meet in the middle.
Stewart said that had the ACA been implemented in its entirety with an expansion of Medicare, Partners would have seen a significant drop in patients.
“It hasn’t, because our folks are those who do not qualify for Medicaid – those not old enough to qualify for Medicare and those who are working on the low end of that economic scale.”
He estimates that many of those workers would have been covered in the expanded Medicare portion of the bridge.
“That portion didn’t happen in Tennessee. The health exchanges did happen so the folks on the upper end [of the economic scale] that we don’t see that many [as patients] were able to get insurance. The part that is in existence affected very few of our folks.”
He said that the dip that the clinic is experiencing may be due in part because many members of the community don’t realize that they qualify for Partners.
“When we see something out there we see it as something valuable, but something valuable for somebody else who qualifies,” Stewart said.
The board members said that they would like to get the word out to potential patients as well as to small business owners whose staff might qualify for Partners care.
“We believe that there is a significant group out there are still yet to be benefited by us, and we just need help reaching them,” Henry said. “We’re here and we have the facilities. We intend to be around as long as we can be.”
Henry concludes that he doesn’t see complete insurance coverage as ever being possible.
“I just don’t see it happening. There is going to people who can’t afford even the subsidies. They’re going be here and we’re going to do our best to serve them.”