For some people, Sunday afternoon is a time for leisure, but not for the volunteers at Pelham’s Cahaba Valley Health Care, where there is a waiting room full of patients.
As the fresh-faced volunteers pass out papers, patients shift in their seats and swap stories. The clinic is one of the few places in the state that offers free dental and optometry services, but only on a first-come, first-served basis. Their clients don’t seem to mind the wait, though. Most, if not all, of them have gone years without seeing a dentist or optometrist. They don’t mind waiting a little longer.
Millicent Voss is one of Cahaba Valley’s patients being seen today. She’s a severe diabetic, and is thus prone to dental problems. All of her teeth are rotten, and about five months ago they started literally falling out of her mouth. She says that she received information about the clinic after being turned away at another healthcare facility.
“They [the first healthcare facility she visited] wanted $40 per tooth, and $1,000 for dentures,” she says. “I don’t make but $721 on disability, you just can’t put that in there.”
Cahaba Valley Health Care was founded by former nurse practitioner Edwina Taylor as a way to offer underserved residents access to treatments that are normally prohibitively expensive. As of right now, Alabama is one of six states in the country whose Medicaid program does not cover dental care for adults. With the average cost of routine dental health services ranging from $75-$300 per tooth, it’s up to community health centers like Cahaba Valley to fill the gaps in coverage.
Unfortunately, the supply of relatively accessible health options is often unable to meet the massive demand. According to Director of Health Promotion and Chronic Disease at the Alabama Department of Public Health Jim McVay, about 30 percent of Alabama’s adult population is uninsured – roughly 1,440,000 residents. Although the Affordable Care Act is generally expected to decrease that estimate, insurers will not be mandated to include coverage to such “unessential benefits” as dental care.
McVay says that community health centers would have received more revenue if Alabama had agreed to expand Medicaid. If it had, the state would have received an estimate of about $1.5 billion in federal funds to help cover adults up to 100 percent of the poverty level – that is, as many as 300,000 people. Medicaid funds would have reimbursed healthcare facilities for services given to the uninsured, resulting in a significantly smaller amount of strain on community health centers. As of right now, most nonprofit health initiatives lack the funding and staff to significantly increase access.
“Alabama has a very high uninsured rate because we have an extremely restrictive Medicaid program,” says McVay. “For low-income individuals, even a sliding scale, a graduated scale in payment can be difficult. People avoid getting healthcare that they need because they can’t afford it.”
Last year, Taylor says that her almost completely volunteer-run team saw more than 800 patients, and the numbers keep increasing. About a month ago, she organized a five-hour health screening in Alabaster, coordinating enough volunteers and resources to serve about 55 patients. Her staff ended up seeing 60 people, but still was forced to turn 40 others away. A significant number of these patients came in with serious conditions. Taylor says that if they don’t receive access to affordable or discounted healthcare at some point, their problems will almost certainly go untreated.
“We have some people that come in and say, ‘You know, I pulled out one tooth with a pair of pliers.’ That’s how bad it hurt,” she says. “There simply isn’t access [to dental health].”
Community health programs cater towards low-income individuals, but Alabama’s healthcare landscape makes it difficult for them to reach populations that many consider the most underserved. For instance, although Cahaba Valley Healthcare is able to offer services without requiring documentation of citizenship, most health initiatives receive government funding, and are thus required to ask their patients for their social security number.
Matthew Buttler, the fundraising and communications director for the Hispanic Interest Coalition of Alabama (HICA), says that this make it incredibly difficult for many Hispanics to receive any sort of healthcare whatsoever.
“Immigration status is always the barrier,” Buttler says. “Since H.B. 56, [many healthcare facilities] are still not accepting tax ID numbers. So whether or not these individuals are paying into the program, they can’t receive services.”
Another hard-to-reach-population for nonprofit health initiatives involves rural communities where access to doctors and dentists are severely lacking. Buttler says that HICA will often refer Birmingham residents to places like Cahaba Valley Health Care, Clinic of Hope, or outreach programs with St. Vincent’s or Cooper Green. For rural residents who live outside of incorporated cities, however, there are very few resources and lots of red tape, Buttler says, especially considering that many urban community centers are only authorized to provide care for residents of their specific county.
Although indigent populations suffer obvious consequences from lacking access to healthcare, McVay says that they aren’t the only who bear the cost. Poor residents who are unable to receive the preventative services or appropriate medication that they need often end up in hospital emergency rooms – the least cost-effective solution for both the individual at risk and the state’s taxpayers.
“If emergency healthcare is provided and not paid for, someone has to cover that cost,” says McVay. “If there is poor health in the community then the cost of that is spread throughout the entire community.”