Office manager Mary Baxter probably has one of the most difficult jobs at Mercy Health Center.
For more than an hour every Tuesday, Baxter must turn away most of the people who call the center wanting an appointment.
There are only nine available appointments for the more than 150 people that call each week and not enough doctors, nurses, volunteers, resources or hours in the day to take care of everyone.
Some patients understand and simply try their luck the next week.
Others have tried for weeks to get an appointment at any clinic; they scream, curse, plead and take out their desperation and frustrations on Baxter.
It’s the most arduous two hours of the week.
The Athens clinic treats a small portion of the more than 1.6 million Georgians and 14,250 Athenians without health insurance.
Since 2000, 7.2 million more people are without insurance, as fewer employers offered coverage, according to a study released in August by the U.S. Congressional Joint Economic Committee.
*Many left out*
A little more than three years ago, Sandy Lewis-Leroy, 54, a patient and volunteer at Mercy Health, found herself choosing between food, clothing and shelter or medical treatment.
She held a steady job with good insurance coverage for decades, but faced a dilemma: Keep her job with the Council on Aging in Ohio or take care of her sick mother. Lewis-Leroy left her job and opted to work as a project manager for an Ohio construction company that allowed her a more flexible schedule.
The only downfall was she wasn’t offered insurance.
“Mom was dying, so I had to do what I had to do. That’s how it all snowballed. I didn’t have a clue. I just took it all for granted because I was never without (health insurance),” Lewis-Leroy said.
After her mother died, Lewis-Leroy was diagnosed with hypertension, rheumatoid arthritis and depression. Without insurance and making too much money to qualify for Medicaid, she was left to borrow money from her children to pay her medical bills – if she could get a doctor to see her at all.
“Even if I had money for the doctor’s appointments, they refused to see me because I would not be able to afford to keep up with the (cost of the) lab work and the tests,” Lewis-Leroy said.
Purchasing her own health insurance wasn’t an option, either, she said, because most companies offering “nongroup” coverage generally refuse to cover anyone with pre-existing medical conditions.
Lewis-Leroy isn’t alone.
Slightly more than two-thirds of Americans – 67.5 percent – drew on private sources for any of their insurance coverage during 2007, according to the U.S. Congressional Joint Economic Committee. The number has steadily declined from 72.6 percent in 2000 because of a shift in employer-provided insurance, which now covers less than 60 percent of the country’s population, the committee said.
A little more than two years ago, Lewis-Leroy made her way to Athens and found Mercy Health Center.
It was the first time since she fell ill that the health care door wasn’t slammed in her face, she said.
The team of volunteer doctors, nurses and pharmacists there treated her hypertension, including medication, took care of her dental needs and helped her to stop smoking through cessation classes.
Now as a volunteer and board member at Mercy Health Center, Lewis-Leroy worries about the patients who find treatment at the facility after years of going without services.
Some patients have gone so long without medical treatment they’re facing the possibility of losing their feet because of untreated diabetes.
“I can’t believe this is going on in America,” Lewis-Leroy said.
*Growing like Topsy*
Two years ago, Hart County couple Albert Carey, 51, and Jan Carey, 49, found health insurance just barely out of reach.
Employed as a truck driver and heavy equipment operator, Albert Carey’s pre-existing health problems coupled with the high-deductible plans his employers offered forced the couple to get by with minimal trips to the doctor and treatments from free health clinics.
Albert Carey’s health continued to decline from untreated Type 2 diabetes, and earlier this year the unthinkable happened – he had a heart attack that required open heart surgery.
If he’d had affordable insurance, if he’d gotten regular preventative treatment, the Careys might have avoided the mountain of debt that they can’t pay.
Albert Carey doesn’t blame his employer for not offering a cheaper plan, he said, because the company’s owner was doing the best he could to get by as well.
Over the past decade, the Careys’ scenario has become more and more common, according to the U.S. Congressional Joint Economic Committee study.
Since 2000, insurance premiums increased by 98 percent, almost five times the rate of overall inflation. The cost increases led some employers to drop insurance coverage, and others to increase employees’ contribution, according to the study.
In 2007, the average worker contribution for employer-provided family coverage grew to $273 per month, more than double the average contribution on $135 per month in 2000. Meanwhile, workers’ wages grew by only 24 percent over the same period.
The cost increases in health care premiums and deductibles are having a trickle down effect for employees, according to the National Coalition on Health Care.
Not only are more people choosing to drop health insurance because they can’t or won’t pay the premium, but the coalition’s study found that last year 50 percent of all bankruptcy filings were partly the result of medical expenses.
Until gasoline prices skyrocketed to $4 a gallon, for the past seven years affordable health care insurance has been the No. 1 complaint for Northeast Georgia’s small-business owners, said Carol McDonell, area director of the Georgia Small Business Development Center’s University of Georgia Athens office.
As the price of supplies, fuel and insurance continues to increase, employers now must choose between staying in business or folding all together, McDonell said.
“It’s survival mode right now,” she said.
*A dying breed*
Watkinsville doctor Cathleen Quillian-Carr decided seven years ago that family practice was the path she was destined to take as a physician.
She loved the personal relationships she could develop with patients and that she could treat generations of families.
But these days Quillian-Carr, like most primary-care doctors, is finding it difficult to make ends meet without giving up those personal relationships.
Every year for nearly a decade, Medicare reimbursements are reduced, slashing primary-care physicians’ payments by at least 40 percent, according the American Medical Association.
“It’s gotten harder,” Quillian-Carr said. “You have to see more patients to make ends meet, but if you see 50 patients a day you lose those relationships.”
Not enough smart young people are willing to go into a profession where they’ll face that choice.
In the past decade, the number of medical school graduates choosing primary care declined by 50 percent, according to a September report by Dr. Mark Ebell, a University of Georgia professor.
The shortage of primary-care physicians now is linked to higher infant mortality rates, overall death rates and more deaths from heart disease and cancer.
It’s also clogging up Athens’ emergency rooms, said Dr. Stephen Lucas, chief medical officer at Athens Regional Medical Center.
Emergency room doctors at Athens Regional will treat at least 63,000 patients this year, Lucas said.
Many of those patients, he said, are using the facility as their main source of health care because they either must wait weeks for an appointment to see their primary-care doctor, are uninsured or because of high-deductible insurance have put off regular doctor visits until their illness was out of control.
Emergency room employees struggle daily to keep wait times low, but with 170 patients to see each day and only 40 available beds, that’s sometimes impossible, Lucas said.
The wait for an appointment to see a primary-care physician is so long that even the medical center’s three regional care facilities have become backed up with patients trying to avoid the long emergency room wait times. The facilities’ doctors treat as many patients each year as its emergency room doctors, Lucas said.
“It’s a problem all over the country to try and get the numbers in the emergency room decompressed,” he said.
In Georgia, 58 of 159 counties, many of them rural, officially are designated as primary-care health professional shortage areas, according to the Health Resources and Services Administration. This means that on average there is less than one doctor for 3,500 people, the group said.
Currently, Georgia needs 259 more doctors in underserved areas to eliminate the shortage, according to the HRSA. To attain that goal, the state would need another 421 doctors.
But with family practice doctors earning the lowest average salary – $185,740 – compared to specialists who had an average salary of more than $400,000, according to Ebell’s report, that’s not likely to happen overnight.
Doctors have a medical school debt that rivals a home mortgage, said Quillian-Carr, who owed $127,000 in education bills when she started her practice in July 2001.
“I’ll probably still be paying it for the next 10 or 11 years,” she said.
The state needs to do more to encourage medical school graduates to enter family practice, Quillian-Carr said, but before that will happen, payments from insurance companies will have to improve.
“As long as (payments) continue to hold steady or decline, you’re going to continue to see a shortage,” she said. “We’ve got to make it worth it (for medical school graduates).”
State officials slowly are starting to take notice of the problem.
The past session, the state legislature recommended a budget increase of $541,461 for family medicine residency programs. In addition, three hospitals that currently do not have residency programs – Athens Regional Medical Center, St. Mary’s Hospital and Northeast Georgia Medical Center in Gainesville – are looking at the possibility of establishing programs that include primary-care specialties.
Hundreds of deaths each year are attributed to untreated or late treatment of chronic illnesses such as Type 2 diabetes and hypertension, according to the National Institutes of Health.
Chronic diseases account for seven out of every 10 deaths and 75 percent of health care spending, according to the organization.
But as Americans struggle with these illnesses, which easily could be prevented or delayed with early treatment and lifestyle changes, the number of uninsured escalates, said Dr. Paul Buczynsky, medical director for Mercy Health.
“It’s kind of a difficult thing for us to gauge because the problem is so overwhelming. There’s so many people that it’s not like we ever feel like we have arrived as far as meeting the need,” Buczynsky said.
It’s frustrating, he said, because easy access to preventative care would lower health care premiums, making insurance affordable for more people and reducing overhead for health care providers.
The Christian-based clinic’s employees and more than 350 volunteers don’t try to solve the problem, they simply try to provide quality health care with the $250,000 budget each year they have to offer.
“We can’t fix (the problem), and anyone who says they can is kidding themselves,” said Tracy Thompson, executive director for Mercy Health Center.
The patients who seek treatment at the Oglethorpe Avenue center can’t afford insurance and don’t qualify for Medicaid or Medicare benefits, Thompson said.
Many patients are working poor who either are employed with two part-time jobs that don’t offer benefits or high-deductible, unaffordable insurance or those, who because of an illness, lost their jobs and subsequently their insurance.
“These are the people that must ask, ‘Am I going to put food on my table and gas in my car or am I going to take advantage of the health benefits from my employer?’ ” Buczynsky said.