Monday January 21, 2013

BENNINGTON -- Despite historic health care reform at the state and federal level, principals at the Bennington Free Clinic see a continued need for no-cost care for some time to come. The clinic opened Jan. 16, 2009.

"I hoped it was a short-term solution," said the clinic's founding medical director, Richard Dundas, a recently semi-retired local internist. "I'm still hopeful it might be."

Eying the future, the clinic hopes to build capacity to focus on the health of patients "above the neck" -- dental and eye care and eventually mental health. A dental initiative has been budgeted for this year in addition to ongoing preventative and acute care programs.

The state of ongoing reform

Although on track to "universally available" health insurance coverage following along the lines of federal law, health care in Vermont remains in flux and current reforms are seen by state officials as a bridge to an envisioned single-payer system (Green Mountain Care) occurring sometime after 2017.

Even under the best-case scenario, gaps in coverage will leave thousands un- and underinsured for the foreseeable future.

"One of the things we see even now is just because someone is eligible for a state health insurance does not mean they keep it," said Sue Andrews, the clinic's executive director.

Each patient through the door is screened for eligibility and offered assistance to apply.

"We get lots and lots of people on state health insurance, but frequently they get on and there's a premium," Andrews said. "And the premium may be as low as $7 a month, but more likely it's $30 or $60 a month."

Often, those payments are affordable for a month or two, "and then the third month the brakes go on their car, and they don't pay the premium -- they get their car fixed. And that's not going to change with the new health care system," Andrews said in a recent interview at the clinic, located at the Nichols Education Building offices at the First Baptist Church on Main Street.

"What we need is nationwide universal health care," Dundas said speaking Sunday by telephone.

Vermont's health benefit exchange is scheduled for individuals and small businesses in 2014 with open enrollment beginning this Oct. 1. Because individuals will still be tasked with paying into the system through the insurance market, questions remain about affordability and other issues like limited open enrollment periods.

Since 2006, the state appropriation for member clinics in the Vermont Coalition of Clinics for the Uninsured (VCCU) has remained flat at about $640,000. Over the same period of time, the number of free clinics has increased from nine to 10 (with Bennington's) and the amount of patients has nearly doubled. Bennington's clinic receives about $45,000 a year in state funding, or roughly two-thirds of its operating budget. Additional amounts come from grants, local ballot appropriations, and fundraising including an annual March event at Prospect Mountain.

An ounce of prevention

Statewide, the VCCU tallies between 6,000 to 6,500 patients over the past year, resulting in an estimated $4 million in avoided emergency room costs. "People who come here frequently -- not 100 percent, but largely -- are people who, if we weren't here, they'd go to the emergency room," Andrews said. "So we are avoiding huge costs."

"There's huge savings," Dundas agreed. "I think funding for (free clinics) is a good deal for the state."

The clinic is a program of Greater Bennington Interfaith Community Services Inc., which also organizes the Food and Fuel Fund and Bennington's Kitchen Cupboard food pantry. Charlie Gingo, a board member, said he encountered good awareness about the clinic while collecting signatures recently for a ballot appropriation.

"I think there's value in having to go get the signatures," Gingo said, given the added exposure for the organization. "It's not just a small group of (board members running the clinic) ... It's really a community saying this is something we need to do for the people who live here who can't get insurance, who don't have insurance for whatever the reason may be, and I just think the commitment is impressive."

Dundas said the volunteer support had been beyond anything he expected. With most physicians' clinical practices packed, "here I am asking them to do even more." And they did.

Dental and eye care are hurdles for the clinic, which functions wholly on volunteering physicians, nurses, physical therapists and laypeople. Mental health is also a consideration with much of the clinic's population.

"The reality is, these are people who are having a really tough time of it financially," Andrews said. "Who wouldn't be anxious? If you don't know how you're going to make rent this month or put food on the table?"

Issues of substance abuse are another health arena that the clinic cannot currently address; although it does provide referrals. But the main hurdle remains ensuring "people have ongoing access to a secure medical home," Andrews said. She said she was proud of women's preventative clinics offering age-appropriate screening for breast, cervical, and cardiovascular health. Patients' Body Mass Indexes (BMI) are also calculated and discussed.

The clinic is open Thursday evenings and Monday mornings by appointment, which may be set up by calling 802-447-3700. More information is available at www.benningtonfreeclinic.org.

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