Into Coronavirus for the Uninsured
Penny Wingard: What concerns me if I get sick, am I gonna get the possible best care? That frightens me more than anything.
Trymaine Lee: Meet Penny.
Wingard: Hi. My name is Penny Wingard (PH). Well, actually it's Penelope Wingard. My friends call me Penny. And I'm 56 years old.
Lee: Penny has lived in Charlotte, North Carolina, for 20 years. She doesn't have a lot of money. But her friends say she has a big heart, that she's always generous with her family and other people in need. But Penny has been going through a really tough time. In 2012, she was laid off from her job as an after school teacher. And then in 2013, she was diagnosed with breast cancer.
Wingard: Well, when the diagnosis came through that-- I was stage II, (MUSIC) had breast cancer, I was devastated. I was scared. I didn't know what to do.
Lee: She went through chemotherapy and then radiation. But other health complications followed. Penny developed high blood pressure. And she had an aneurism.
Wingard: I had panic attacks year before this. But I went into therapy, and was able to control them. But my panic and anxiety attacks, you know, got worse after the diagnosis.
Lee: And when Penny's cancer treatment ended, she no longer qualified for Medicaid. And she couldn't afford insurance through the Affordable Care Act. Today, Penny is cancer free. But she's also one of the 30 million Americans who are uninsured, now facing a pandemic with no health coverage.
Wingard: I'm really anxious. I honestly wish right now I was in some kind of therapy to relieve all this anxiety that I'm feelin'. But I'm not. And I can't afford to go to a therapist. The coronavirus is just adding more anxiety onto everyone, not just me, but to everyone. (MUSIC)
Lee: I'm Trymaine Lee. And this is Into America, a podcast about politics, about policy, and the power that both have in shaping the lives of the American people. As the coronavirus continues to spread, we're going into Charlotte, North Carolina, to find out how people who've fallen through the health care coverage gap are fighting to stay healthy during this crisis.
Meredith Niess: One of the interesting things about coronavirus is that it almost simplifies the difficulty of the uninsured.
Lee: And how doctors on the frontlines of care for the uninsured are trying to protect them.
Niess: It's bringing to light some systemic problems that have existed for a long time.
Phil McCausland: Penny is, she's definitely a strong woman. And she's gone through quite a bit before even this.
Lee: My colleague, Phil McCausland, is a national reporter for NBC News. He covers the social safety net. To better understand what the uninsured are going through right now, Phil talked to Penny Wingard several times over the past few weeks.
McCausland: And just every time I'm talking to her on the phone, I can just tell increasingly each day, she just feels more and more overwhelmed.
Lee: Penny is still working during this outbreak. She drives Lyft on the side, and is a part-time caretaker for an elderly woman. It's a gamble Penny is making in order to survive. She knows it puts the people around her at risk, and leaves her even more vulnerable.
McCausland: So Penny was diagnosed with stage II breast cancer in 2013. And after going through chemo, it was a really brutal time of chemotherapy. She's had to maintain a certain number of medications. And those medications, one of the side effects, is she has a weakened immune system. Every six months she has to get her white blood cell count taken by a doctor.
Wingard: So where some people may get a cold, or something like that, if I get a cold or sinus infection, it's more prominent than other people that who may get a cold or a sinus infection, or even the flu.
McCausland: So, I mean, you can only imagine what that fear is right now, right, with this coronavirus pandemic growing, and this outbreak spreading.
Wingard: I mean, every time I go to the store, I'm backing, you know, away. I had to tell a gentleman the other day, you know, could you please stand 6' apart from me? Because the people here in Charlotte, North Carolina, they're not takin' it seriously. (MUSIC)
McCausland: She doesn't have a lot of money to her name. She's havin' trouble buying supplies for herself. And she's just consistently more anxious and more scared of where this all leads.
Lee: So clearly she's goin' through it emotionally, and she's physically more vulnerable. But she also doesn't have health insurance. What exactly happened?
McCausland: She had health insurance through the Medicaid program. And it was helping her treat stage II breast cancer.
Wingard: But the day that my radiations stopped, the next day my Medicaid stopped.
McCausland: She was immediately kicked off the rolls. She lost her health insurance. And so she's had to kind of turn to a piecemeal system, that I think a lot of Americans turn to.
Wingard: Every other doctor afterwards was connected to slidin' scale. And if they were not, basically payin' out of pocket to see 'em.
McCausland: She's had a lot of doctors who she says, you know, have been really charitable to her to help take care of her. But she's also amassed quite a bit of medical debt too. Because she's had other health issues come up. And she has to maintain certain medications after breast cancer. (MUSIC) Do you know how much medical debt you have right now, and?
Wingard: What the lady told me from the credit people, it's over $25,000 that I have accumulated from 2013 to currently now.
McCausland: Are you gonna be able to pay that off? I mean, is there any hope of paying that off?
Wingard: No. I have no way of payin' that off. The creditors call me every day. And I tell them my situation. And I have no way of payin' that off. (LAUGH)
McCausland: I hope you don't mind sayin'. But, I mean, I know people hangin' onto that debt is a lot, gettin' those calls is a lot. I mean, how does that make you feel?
Wingard: It's very, you know, you didn't ask. Sorry. You didn't ask for any of this. And you didn't ask to get sick. You know, it's not something that you went out there and said, "Oh, okay." You know, you didn't ask for any of it. And it's a burden. And it really is a burden. (MUSIC)
Lee: Now, there are government programs to help get people on the insured list. Why isn't she insured? Is there no avenue for her?
McCausland: Right now, there's no avenue. So Medicaid is the program for folks in her position, low income people in the United States under age 65. They can get health insurance through that. But there's certain rules. And you have to meet them. And Penny, unfortunately, doesn't, especially in her state. So North Carolina and 13 other states haven't yet expanded Medicaid, which was something that was offered through the Affordable Care Act.
People might know it as Obamacare. And it basically gave states the option to take on a large amount of money from the federal government, and in exchange, they would promise to insure a greater number of people. A lot of these states are controlled by Republican legislatures. And they say in order to expand this program, we have to pay a certain amount.
So they have to match 10% by 2020. And they're just not willing to do that. Part of it is being a fiscal conservative, maybe. But there is a bit of an ideological bent to this. You know, people don't wanna support Medicaid expansion because of the optics of supporting Obamacare, and what that sounds like. So Penny is childless, and in those terms, it means in North Carolina, because they didn't take on this money, she can't get coverage. She's applied a couple times. But they've denied her each time.
Lee: So how many people like Penny are there out there?
McCausland: I mean, North Carolina, you're lookin' at somewhere between 400,000 and 500,000 people who are livin' without health insurance because the state chose not to adopt this program. Nationwide, you're lookin' at maybe 5 million who would be eligible. But again, these states, Alabama, Florida, Georgia, Kansas, Tennessee, Texas, you know, and more, they all chose not to go through with it. So Penny is definitely not alone. But she's definitely just makes clear how vulnerable these folks are, and how vulnerable that makes our entire health care system when we're faced with a pandemic.
Lee: So you have the politics of everything, and you have people like Penny. And then you have the pandemic. Where do people like Penny, who have found themselves in a situation, where do they go for care?
McCausland: So Penny goes for care to a hospital group that is able to treat her on a sliding scale. So they basically, they do an accounting of all your earnings. And they say, "Well, we think this is how much you can pay." And she has to go there regularly, right, for the different health issues that she has. And she went just last week. And she told me, "You know, it was scary to go there."
Wingard: I was talkin' to the nurses. And I said, "Wow." I said, "You know, you got people in here coughing." Because I had on gloves, a mask and everything when I went in there. And I said, "You got people in here coughing. Why aren't you guys protecting yourselves?" And the nurse said to me, "We don't have any masks. We don't have any protection."
McCausland: The staff wasn't able to wear masks, 'cause they have a shortage. So for her, it's just an added pressure, and an extra thing to be nervous about, in kind of her battle to get coverage, in her battle to get treatment, you know, day-to-day. Some people are spendin' two weeks in the hospital for this. Obviously that's a lot of cost. Are you worried about the cost of gettin' sick?
Wingard: Of course. I am worried about the cost. I'm already in debt with hospital bills. So on top of that, that would be more debt. You know? So yes, I'm worried. I'm really worried.
McCausland: And so it's, I think, really incredibly scary to her to think about can I even think about going to the doctor if I get the coronavirus? (MUSIC) Can I afford to live with the debt that I'll have to take on? It's a really difficult calculus that I think many people are gonna be making in the coming weeks unless something's done about it.
Lee: After the break, we'll hear from a doctor who served the uninsured population in Charlotte, North Carolina. Hang with us. (LONG PAUSE) We just heard about Penny Wingard who is immunocompromised and one of the millions of Americans who are uninsured, and especially at risk during the pandemic.
But organizations that treat people like Penny are struggling too. Many of them are what are known as community health centers. They're basically clinics that rely heavily on federal funding to serve people who have difficulty affording care.
McCausland: They were established by the federal government through the War on Poverty. They're there to treat the uninsured, the underinsured. There's about 1,400 of them across the country. They serve millions of people. (MUSIC)
Lee: Phil talked to a doctor who is working around the clock at one of these clinics to serve this population.
McCausland: I talked to Dr. Meredith Niess. And she is the medical director of the Charlotte Community Health Clinic.
Niess: I'm also an internal medicine physician.
McCausland: So she lives in Charlotte. She's from Charlotte, just like Penny. These clinics, they deal with that population. They're there to help that population.
Niess: We certainly are serving a lot of the working poor, which is a real challenge for us. These are mostly folks who have jobs. Often they have multiple jobs, but are living under the poverty line, often with many family members, also living with them. We have a lot of patients who have unstable housing situations, who rely on public transportation to get places.
McCausland: And Dr. Niess, 83% of her patients don't have insurance right now.
Niess: The lowest end of our sliding scale is $25, which is the charge that if patients are able, they pay when they come for an appointment. So when 83% of a clinic's patients are paying about $25 a visit, it, as you can imagine, doesn't come anywhere close to covering costs.
Lee: Now with the coronavirus pandemic, and all the stress on the health care system, how are clinics like Dr. Niess's faring? How are they holdin' on?
McCausland: We're still early days. And this is a big shock to the system. And I think it's really, she says pretty openly, we're really seeing the huge systemic gaps in the health care system, as we've built it.
Niess: And one of the interesting things about coronavirus is that it almost simplifies the picture of the difficulty of the uninsured. It's bringing to light some systemic problems that have existed for a long time.
McCausland: People getting access to care is a major issue.
Niess: We are receiving a massive influx of requests for new patient visits, which is a big problem for a lot of reasons, one of which is that problem that we are a relatively small clinic, and just don't have space. We already had a three month wait list before we had this massive influx of requests for new patient visits.
A lot of these patients who are requesting visits, it's because they're afraid they have coronavirus. And we would like to help with the triage of that. But there's a lot of complicating factors in terms of our limited resources. One is testing. We have a total of 25 tests available.
McCausland: Before (BACKGROUND VOICE) congress said that all tests were free, before they passed that bill last week, she had to send someone to get tested. And it cost 'em $50. So they said.
Niess: "I'm gonna pass because I won't be able to have groceries this week if I do that." So we ended up bringing them into our site. And one of our providers went out to the car, and swabbed their nose in their car, in order to test them for coronavirus. And we're still awaiting those results. So this is not a scalable option for these patients. And we have over 100,000 patients or individuals in Charlotte without insurance. So my question is what's gonna happen to the growth of coronavirus in that population? And the answer is that it's going to spread quickly.
Lee: So Phil, how else is Dr. Niess's clinic being affected by the pandemic?
McCausland: Everyone's struggling to get supplies. These clinics are further behind because they don't stock a lot already, right? Because they don't have a lot of money. They have to be a little bit wise about how they're spending that money.
Niess: We keep the minimal supply of paper or of extra exam room supplies that we can. Because we can't afford to be overstocked.
McCausland: Then there's the other aspect of social distancing, which they're tryin' to practice, and encourage. You know, where their clinic is, it's tough to get to. You have to take the bus or public transportation to get there. Then they have to walk into the front door. And they have to go up to the third floor, into an elevator.
There's just a lot of possible contact there. So they're tryin' to get people to onto telehealth options, doin' email, phone and video. And the Trump administration has pushed for health care providers to do that as well. But it gets really tough for these community health clinics.
Niess: While that $25 copay that our patients work very hard to pay us isn't a lot, it's also all the money that we make off of our 83% uninsured visits. And if we switch to telephone, video or evisit, that will turn into zero income for our clinic. And we will be working for free.
McCausland: They're not running these people down to pay. And, you know, they're just kind of eating it. And they're fine with that, because that's what the work is. But it's making that margin even tighter. And it's making them really scared of what their future can be as they're continuing to treat the coronavirus pandemic.
Lee: The truth is, the budgets at community health centers across the country were tight before the pandemic hit. About 70% of their funding comes from the federal government. And even though community health centers get bipartisan support, since 2016, congress has only approved money to support them for two years at a time.
The current funding runs out in May. The first coronavirus aid package that congress passed included an additional $100 million for these health centers. But because some centers operate multiple sites, that comes out to less than $8,000 per clinic. Dr. Niess says that's nowhere near enough to make up for the lost income durin' this crisis. So what's at stake?
McCausland: So, I mean, we're talkin' about them possibly havin' to shut their doors. If nothing changes to that model, how long can you guys hang on? I hate to ask that. But yeah. (LAUGH)
Niess: Oh. I don't think I'm emotionally prepared to answer that question. (LAUGH) This is the reality of working in community health, particularly in a state with an uninsured rate as high as North Carolina's. I sometimes will use the analogy that an organization in poverty is not unlike a family in poverty, where it's just kind of one crisis to the next. And you often feel like there's no way you're gonna make it onto the next one. But somehow you keep moving forward.
McCausland: That congressional funding, though, in May, I mean, is obviously key to be renewed, right? Would centers like yours be able to stay open if they didn't reauthorize that funding?
Niess: No. No. If congress doesn't reauthorize the community health clinics, that is the end of the community health center program. It would be absolutely just an unmitigated disaster for our overall health care system, especially in the setting of the coronavirus pandemic.
Lee: We mentioned there are 30 million uninsured Americans across the country right now. What are their options? And is anything bein' done to protect those communities?
McCausland: So there are several states that are reopening that ACA enrollment. States are asking for waivers from the federal government to expand care. Even in non-expansion states they're asking for waivers to use those Medicaid dollars in a different way, to maybe address treatment head on. But right now, for non-expansion states, the options are still pretty limited.
Lee: So when, you know, we mention those big numbers, 30 million uninsured, and the cost of delivering care to them, sometimes the individuals get lost. And Penny is one of those individuals. How is she just dealing with all of this right now?
McCausland: I think she's struggling with it a great deal. (MUSIC) The anxiety's up, for sure. But she said, "You know, I just can't concentrate on the fact of possibly getting sick. I can't become that person who's constantly, constantly afraid."
Wingard: I'm not gonna even think negative, that I'm gonna get this virus. I can't let myself think that way. I have to think hopefully I'm gonna do whatever it takes. I'm not talkin' about just for my life. I'm talkin' about for other lives as well.
Lee: If you don't have health insurance, or you know someone in this situation, you can look up a community health center in your area on the website findahealthcenter.hrsa.gov. That's findahealthcenter.hrsa.gov. You also can find a link on our episode page.
Just be aware they might have long waits during this time. Into America is produced by Isabel Angel, Allison Bailey, Aaron Dalton, Max Jacobs, Barbara Raab, Claire Tighe, Aisha Turner, and Preeti Varathan. Original music by Hannis Brown. Our executive producer is Ellen Frankman. Steve Lickteig is executive producer of audio. I'm Trymaine Lee. We'll be back next Thursday.