On December 30, 2005, while the nation was fat and sleepy from Christmas cookies and holiday celebrations, HR3010 was quietly signed into U.S. law. The appropriations bill established a budget for the Department of Labor, Health and Human Services, and Education and Related Agencies. Elected officials on both sides of the aisle criticized the bill. Fiscal conservatives, like our own senators Lindsey Graham and Jim DeMint, accused the bill of being the pork-padded variety.
To make room for piggy, cuts were made to a number of education and health care programs. No Child Left Behind, National Institutes of Health research grants, state and local bioterrorism grants, and college education Perkins loans had funding slashed or eliminated.
AccessNET is a local Charleston organization that was hit particularly hard by the bill. AccessNET represents a consortium of health care partners throughout the tri-county area. As a component of the local Palmetto Project, whose mission is to "put new and creative ideas to work solving problems in South Carolina," the organization coordinates health care providers, businesses, civic groups, schools and religious organizations to get health care to the 242,509 residents that are uninsured or underinsured. This total is 43.1 percent of our Lowcountry population. HR3010 eliminated federal funding for the program's Health Resources and Administration grant.
Laura Morris, project director for AccessNET, is discouraged by the budget cut, saying, "AccessNET was born out of the frustration with a sad situation in which too many of our neighbors are suffering from debilitating diseases and even early death in an area blessed with a wealth of health resources."
Focusing on getting care to those with the highest poverty rates and poorest health outcomes, the program has created a network of patient navigators (PNs) that are used to coordinate care. The PNs help patients navigate through the maze of health care bureaucracy, and follow up to make sure appointments are kept and patients are clear about instructions and prescriptions. PNs even provide transportation to and from doctor visits. These simple services ensure thousands of Lowcountry residents are getting the health care they need.
"The sheer numbers of services and knowledge of who provides what services to whom is overwhelming to the average citizen, much less to the large number of residents who have no source of payment for care and may face other barriers such as language and lack of transportation. More often than not, care for these citizens is uneven and episodic. Few have regular medical providers, and even fewer are sufficiently medically literate to seek out appropriate care," says Morris.
Evelyn Jamie, PN at MUSC Children's Center says, "This is a great program. We don't just do health care, we do Head Start enrollment, deal with passports and immigration, the social security office. Most of the people I deal with speak Spanish, and getting them to know what is expected and getting them prepared is what is important. Every requirement in every office is different and they need an introduction to the process. It is very educational for them. I just wish the funding was made available, this service is very important. I'm there for people when they don't have it so good, and I like that I am helping them out."
In order to provide care, AccessNET has developed partnerships with providers throughout the region. MUSC, Sea Island Medical Center, Santee-St. James, and East Cooper Community Outreach are just a few.
These providers benefit from AccessNET's efforts as well. Laws like the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Prudent Layperson law require that an ER treat you regardless of your insurance status. In many cases, this is the only way an uninsured individual can gain access to the health care system. As a result, ERs are overflowing and quality of care is compromised. Attaining continuity of care is also extremely difficult under these conditions. "As with many communities, emergency rooms continue to be a magnet for people seeking non-emergency care," observes Morris. "Absent a central, easily accessible focal point for providers and consumers to meet, health care providers will remain overwhelmed and the needs of the uninsured and underinsured population, whose rates of preventable chronic disease alone are considered to be at epidemic proportions, will remain unmet."
Both S.C. Democratic Representatives voted "no" to HR 3010, all four Republicans voted "yes." If one Republican representative had changed his vote, South Carolina would have approximately $3.5 million more to improve the health of half the counties in the state.
Congressman Henry Brown, who represents District 1 including Charleston, voted to support the passage of HR3010. When his office was asked for a statement regarding the funding cuts that will affect nearly 250,000 Lowcountry residents, Sharon Axon, Rep. Brown's communication director, responded by saying, "We will need to get up to speed on this."
As for AccessNET, the Health Resources and Services Administration has approved an extension of the original federal grant, which will allow them to use remaining funds through February 28, 2007. After that date, funding for the program is unsecured.