JIM LEHRER: And finally tonight, another in our ongoing series tracking the federal stimulus money. Tonight, a boost for community health centers.
Correspondent Betty Ann Bowser reports from a clinic in northeastern Ohio for our Health Unit, a partnership with the Robert Wood Johnson Foundation.
BETTY ANN BOWSER, NewsHour correspondent: Just a few months ago, this busy community health center in Lorain, Ohio, was on the verge of financial collapse.
STEPHANIE WIERSMA, Lorain County Health and Dentistry: I think it’s fair to say Lorain County Health and Dentistry was at death’s doorstep six months ago.
BETTY ANN BOWSER: Stephanie Wiersma is the center’s president.
STEPHANIE WIERSMA: We had to literally monitor every dollar coming in and going out to be sure that we could survive another month.
BETTY ANN BOWSER: That was before it became one of the nearly 1,200 similar centers across the country to get a piece of the $2 billion in the stimulus package targeted for community health centers.
Community health centers were created in the 1960s as part of President Johnson’s war on poverty. They’re a safety net for the poor and uninsured, nonprofit centers that provide health care to anyone who needs it, regardless of ability to pay.
DAN HAWKINS, National Association of Community Health Centers: About 40 percent of the 18 million people served by health centers nationally are totally uninsured.
Cutbacks hurt organizations
BETTY ANN BOWSER: And that's part of the problem, says Dan Hawkins, policy director for the National Association of Community Health Centers. The centers, which rely on a combination of Medicaid payments, grants from foundations, and some federal, state and local funding are under intense financial pressure since the economic meltdown.
DAN HAWKINS: What I hear consistently is one or more of three things happening. Number one, new patients coming in the door in huge numbers, spikes of especially uninsured. Secondly, cutbacks in state and local funding, in particular, even philanthropic foundation funding.
Here is where the federal stimulus, the economic recovery legislation is going to help tremendously to allow them to actually expand and serve more people and offset, hopefully, some of the losses.
BETTY ANN BOWSER: Lorain County Health and Dentistry has been especially hard-hit, so its share of the stimulus money, $1.4 million, came just in the nick of time.
STEPHANIE WIERSMA: We were looking at closing the doors entirely. We settled for, if you will, raising our minimum fees for uninsured patients, capping the number of uninsured appointments each day, and closing the midwifery service in October of 2008.
BETTY ANN BOWSER: Those changes left hundreds of people in the area, many without jobs and health insurance, with no health care.
STEPHANIE WIERSMA: We had created another barrier for our patients. It felt terrible. We couldn't keep up with the demand. And we couldn't even keep up with the amount of uninsured care we had been providing for the first eight months of 2008, roughly $45,000 a month. We couldn't do that.
Downturn creates poverty
BETTY ANN BOWSER: The health center operates two locations in the heart of Lorain, a battered Rust Belt city about 30 miles west of Cleveland. The center has a staff of 44 that serves about 13,000 people, providing primary care to children and adults, prenatal care, and general dentistry.
DOCTOR: So we just check the fundal height to make sure the baby is growing.
BETTY ANN BOWSER: Lorain's patient population mirrors the national picture for community health centers: 63 percent live below the federal poverty line. And these days, more and more of them are jobless.
Lorain has one of the state's highest unemployment rates, nearly 12 percent.
That's higher than the national average, and if you're in downtown at rush hour, it's not too hard to figure out why. Â Main Street looks like a ghost town. Boarded-up businesses, bars, and abandoned storefronts are everywhere.
This used to be a bustling manufacturing hub, the economy driven for decades by steel and cars, but the Ford plant was shuttered in 2005 and now is for rent.
The sprawling steel mill here is practically on life support after waves of layoffs. Then came the economic meltdown. It dealt the crowning blow.
But since getting its stimulus money in March, the center has been able to reduce its minimum fee for an office visit for the uninsured from $40 to $30. That made a big difference to patients like Ceberta Gilles, who had been putting off doctor visits to monitor her high blood pressure because of the cost.
CEBERTA GILLES: I know it's only $10 difference with the $40, but you wouldn't believe. It's so much easier: $10 can fill a gas tank, put a meal on the table, pay a bill. And if you've got something else that has to be done, if you have to have gas in your truck to get to work, then you have to do it.
Funds used to expand clinic
BETTY ANN BOWSER: At one time, Gilles had health insurance when she worked at a manufacturing plant. Then she got laid off. And now in the current economic climate, the 59-year-old can only find part-time work as a pharmacy technician. That means she isn't eligible for the company's health benefits.
CEBERTA GILLES: If it wasn't for the Health and Dentistry, I don't know. I wouldn't be seeing a doctor, period. Without it, I wouldn't have any medical care, and I could get sick again. Then I couldn't work. Then I'd end up on the street, because if you can't work, you can't pay your bills, and you don't have anything.
STEPHANIE WIERSMA: This is an area in our health center that we haven't used for about two-and-a-half years...
BETTY ANN BOWSER: Stephanie Wiersma has already decided how she will spend the stimulus money. She knows it's a one-time two-year program, so she's going to use some of the funds to expand now.
STEPHANIE WIERSMA: We'll be able to add physicians and nurse practitioners and reopen this clinic space. With three physicians, we should be able to see another 63, 65 patients a day.
Well, thanks for coming in today. You're interested in a nurse practitioner position?
BETTY ANN BOWSER: She's been interviewing candidates and estimates, with the new hires, the health center will be able to triple the number of uninsured patients it treats.
J.B. SILVERS, Case Western Reserve University: Now that they've taken on Medicare money...
BETTY ANN BOWSER: J.B. Silvers is a professor of health services and finance at Case Western Reserve University. He says the stimulus will not only create jobs in health care, it will also stabilize the health of a vulnerable population of Americans at a crucial time.
J.B. SILVERS: As a safety valve for the system, when things go wrong and people lose their insurance, this becomes much more critical.
They do keep the workforce in working status. They're letting people that are unemployed now continue to have health care so that, when the economy recovers, they'll be in the shape to actually be able to have jobs and grow again. They're stabilizing communities that otherwise are deteriorating.
Stimulus funds stabilize center
BETTY ANN BOWSER: The stimulus money has been a stabilizing influence for Bobby Yost's children, who need the Lorain County health center for health care. Yost turned to the Lorain center when he was unable to find any private doctor who would take their Medicaid insurance.
Yost works full time, but cannot afford her company's insurance plan for herself.
BOBBI YOST: Usually I don't have the extra money to spend on stuff like that. I'm a single mom. I don't get food stamps, nothing right now. All I have is medical for them through the welfare.
BETTY ANN BOWSER: Well, what do you do if you get sick?
BOBBI YOST: I just kind of override it, just let it go.
BETTY ANN BOWSER: Would you go to the emergency room?
BOBBI YOST: If it's bad enough.
BETTY ANN BOWSER: Yost's friend, Jessi Killean, does the same thing. Instead of seeking health care at Lorain County Health and Dentistry, she goes to the emergency room several times a year when she has an asthma attack.
JESSI KILLEAN: I've been doing it for eight years. I haven't had health insurance since I was 25.
BETTY ANN BOWSER: Killean estimates the bills run between $500 to $1,000 per visit. And she knows the hospital will never be able to recover the money because she has no job.
JESSI KILLEAN: And then I just let them put me in collections for the bill, because I can't afford it. I don't worry about it. I look at it and say, "Oh, it's a hospital bill," rip it up, and throw it away.
BETTY ANN BOWSER: And when people like Kaleen go to the emergency room, especially when it's not an emergency, it drives up costs, because the E.R. is much more expensive than a visit to a doctor. In fact, last year at just this one hospital in Lorain alone, un-reimbursed care hit a whopping $20 million.
STEPHANIE WIERSMA: And I have to tell you, I think we can help you.
BETTY ANN BOWSER: That's one of the reasons Wiersma encouraged Killean to seek care at Lorain County Health and Dentistry. It's all part of the mission of all community health centers: to use the stimulus money to reach more people.