The search for sustainable healthcare in WNC

Despite high hopes for Obamacare (aka, the Affordable Health Act), not all residents of Buncombe and surrounding counties have benefited from the national effort to extend insurance to ­­those who can’t afford it. Part of the shortfall is blamed on North Carolina’s decision not to expand Medicaid. Meanwhile, nongovernmental caregiving entities in Western North Carolina, from community health centers to herbalists, are helping people without insurance receive the care they need. While some argue that access to health care should be considered a human right, most would agree that it is essential to a sustainable society.

Moving toward coverage

Staff and volunteers at local nonprofits such as Pisgah Legal, the Council on Aging, the Western Carolina Medical Society and Western North Carolina Community Health Services have put in thousands of hours helping folks sign up for coverage through the federal marketplace. All that time and energy has paid off.

Nineteen percent of Buncombe County residents lacked health insurance in the fall of 2013, when people first began logging on to healthcare.gov to explore their options. At the beginning of the 2015-16 open enrollment period, that group accounted for 14 percent. That means more than 12,000 people have insurance who didn’t before the Affordable Care Act took effect — and that’s not counting new enrollees.

And, although Buncombe is the state’s seventh-most populous county, it ranks fourth in terms of Affordable Care Act enrollment.

Short of the mark

When it comes to getting people insured, the South as a whole is still lagging behind the nation. One reason is that most Southern states, including North Carolina, have chosen not to adopt the part of the ACA that allows a federally funded expansion of Medicaid to cover those too poor to qualify for tax credits under the Affordable Care Act.

About 22 percent of the people in Buncombe County are insured through Medicare, which is available to anyone 65 and older. Medicaid, however, as it currently exists, only covers children and their parents if they make less than 45 percent of the federal poverty level ($11,770 for an individual or $24,250 for a family of four). Medicaid does not cover adults without children who make less than 100 percent of the federal poverty line, and it does not cover those with children who make between 45 and 100 percent of the federal poverty level. People in these groups, cannot access affordable coverage through the ACA.

For anyone who is too young for Medicare, who doesn’t qualify for either the Affordable Care Act or Medicaid or who missed the open enrollment period, the prospects for finding affordable health insurance may seem bleak. But there are still ways to avoid falling through the cracks.

Help is available

Community health centers in North Carolina, for example, help fill in the gap by serving about a half-million people per year.

“Providing health services is a human right for all who need it,” says Scott Parker, director of development and collaboration at WNC Community Health Services and its subsidiary, the Minnie Jones Health Care Center. WNCCHS is a federally qualified community health center, one of 38 in North Carolina. It provides primary care, behavioral health, dental care, transportation by bus and translation services — all under one roof, Parker says.

The federal health care law’s “impact on our organization has been minimal,” he says. “The average patient here is at or below 200 percent of the federal poverty level. … Among that group, we can have folks who are uninsured, underinsured or have Medicare or Medicaid. Right now, about 60 percent of our patients are uninsured, which is a high percentage for a community health center [in this state]. In Buncombe County, we’re pretty well considered the primary safety net agency.”

Asheville Buncombe Community Christian Ministry’s clinic offers primary care and medication assistance. Appalachian Mountain Community Health Centers has newly set up a central facility near mission hospital and is working toward targeted satellite locations around the area in high need. Blue Ridge Community Health Services offers many of the same services as WNCCHS but for the counties south of Buncombe.

Project Access, a program of the Western Carolina Medical Society, helps some indigent patients obtain more extensive or specialized care by connecting them with hundreds of volunteer doctors. They also frequently partner with Mission Hospital, which treats many uninsured people each year.

An alternate approach

Traditional organizations aren’t the only organizations trying to provide low-cost or free care to those who need it.

Asheville resident and certified holistic herbalist Deanna Riggan says she recognized that many people are ill because they lack access to health care. There’s an abundance of herbalists in Western North Carolina, and she wanted to break the barrier to holistic community health care. So Riggan founded Blue Ridge Healers Without Borders, a chapter of Herbalists Without Borders, a nonprofit global network of volunteers devoted to aiding communities and countries impacted by natural disasters, violent conflicts, poverty, trauma and other barriers to health and wellness.

Blue Ridge Healers, which is run entirely by volunteers, provides everything from massage to acupuncture to herbal tea remedies, Riggan explains. So far, the group has convened in Pritchard Park, Food Not Bombs gatherings on the UNC Asheville campus and in Cherokee to offer services to those who are looking for free health services.

“I have seen a lot of greed in the health care system,” Riggan says, noting that health care should be affordable. “Practitioners should get paid for what they do, and I think sliding scale is the best way, so that way people who don’t have much money can access it.”

“We want to make health services accessible for locals,” Riggan says. “If providers can offer one free session per week … that would do so much because we have so much here, and no one should be suffering.”