The stories didn’t used to be like this.

Nikki King, executive director of the city’s largest medical clinic for the uninsured, tells stories about a 30-year-old man who had his arm amputated because of diabetes, about patients who come in with advanced-stage cancers with little time to live, and about the long string of people afflicted with hypertension, depression or other chronic illnesses.

“I’ve been here eight years, and the number of chronic cases used to be relatively rare,” said King, who is executive director of Lawrence’s Health Care Access. “Now the stories just keep pouring in.”

They’re also starting to show up in the numbers. The amount of care that Lawrence Memorial Hospital will provide to Health Care Access patients in 2006 is projected to increase by the largest amount in the clinic’s 18-year history.

The hospital provided $1.06 million worth of care – services such as lab work, MRIs and cardiology procedures – in 2005. This year, the amount of services the hospital expects to donate will be $1.92 million.

“They are sicker,” King said of patients seeking treatment at the nonprofit clinic, 1920 Moodie Road. “Folks are coming to us who have been uninsured for a long time. They haven’t had checkups, let alone anything else, for many, many years.”

Working poor

At LMH, Gene Meyer, the hospital’s president and CEO, isn’t surprised by any of it.

“This is really indicative of what is going on in the country,” Meyer said. “And I think, unfortunately, this is totally predictable. People who are uninsured or underinsured have the tendency to put off care until it is really necessary. When they receive that care, they are sicker and are going to require more resources.”

At Health Care Access, King said 70 percent of the clinic’s 1,600 patients have a job. The clinic isn’t designed to cover the most destitute, but is set up to help people who make too much money to qualify for Medicaid but not enough to purchase private insurance.

Manuela Ertmer, LPN, left, Betsy McCafferty, RN, and Maria Kerby, office manager, work in the Health Care Access clinic, which provides health care to uninsured people in the county. The clinic has seen a rise in people who have put off doctor's visits until their illnesses are so advanced that treatment options are limited.

According to a new survey by The Kaiser Family Foundation, a nonprofit, private operating foundation focusing on the major health care issues facing the nation, the average American worker in 2006 paid almost $3,000 per year for a family insurance plan provided through the employer. Premiums increased by 7.7 percent in 2006, which was more than double the average wage increase of 3.8 percent. During the last six years, premiums have increased 87 percent.

“It is mostly the working poor that we see here,” said Lori Winfrey, nurse practitioner with Health Care Access. “We have a lot of people with part-time jobs or temporary jobs that don’t offer health insurance. We have a lot of construction workers who work for smaller companies that can’t afford it.”

While Winfrey applauded efforts by the state to do more to cover children, she said there still is much that could be done to address the needs of her patients.

“I don’t know if anything is going to change,” Winfrey said. “I don’t want to sound like it is hopeless, but I think money is getting cut everywhere.

“I see some programs that make me think that maybe we’ll get healthier kids, and that would be great. But the working poor are still really falling through the cracks.”

Take care

Patients aren’t blameless in all this either. That’s sometimes tough to say, but Winfrey and King often talk about the role that people’s lifestyles play in the increasing severity of medical cases that the clinic treats.

For example, the top three diagnoses at Health Care Access are conditions that often are associated with lifestyle issues: diabetes, hypertension and cholesterol problems. That’s far different than just a half decade ago when colds, flu and urinary tract infections made up a lot of the cases.

“There are still a lot of people smoking,” Winfrey said. “There is a huge epidemic of obesity and diabetes. We are diagnosing diabetes one, two, sometimes three times a week.”

But Winfrey said the problem is more complicated than simply telling people to eat healthier.

“It is tough when it is cheaper to go to some buffet place and eat for $2.99 than it is to go to the grocery store and buy fruits and vegetables and chicken,” Winfrey said. “I do understand that sometimes people are making choices between eating and paying their medical bills.”

Seeking solutions

In Meyer’s office these days, there’s a copy of a Los Angeles Times article on health care that amuses him. It is about how the U.S. health insurance industry proposes to extend coverage to nearly 47 million uninsured Americans within the next 10 years.

But as the article stated, the proposal was missing some “key specifics,” such as how to control costs over the long run and how to pay for the proposal’s 10-year price tag of $300 billion.

Yeah, Meyer keeps the article around for laughs.

“It is not rocket science to put together a proposal, but it is rocket science to figure out how to pay for it,” Meyer said. “I don’t think any state is doing enough right now, but where are you going to come up with the money?”

States are looking for answers. In one of the more widely reported examples, Massachusetts recently passed a law that will require every resident to have health insurance by July 2007. Legislators in that state reasoned that if it is the law that every driver must have auto insurance, it should be a law that every resident have health insurance.

The program recognizes that some people will have to receive a large subsidy from the government in order to afford health insurance. It also requires companies that don’t provide health insurance to their employees to make an annual payment to the state.

Meyer isn’t sure whether the approach will work, but he is confident that nationally something has to give.

“I think we’re headed to a revolution, not to be overly dramatic,” said Meyer, who teaches a health policy class at Webster University in Kansas City, Mo. “I think we’ll get to the point that it will cost so much even for people with employer-sponsored plans that people will demand something be done.”

Back at Health Care Access – which relies on city, county and state funding, along with donations from physicians, pharmaceutical companies and the public for its $400,000 budget – King tries to keep a positive perspective.

She estimates that her clinic saves the hospital millions of dollars by decreasing the number of people who use the emergency room as their primary means of health care. And she said the best days at the clinic are when patients no longer need its services because they now have insurance.

“Really, every day is inspiring because we are helping people get better, stay at their jobs, get better jobs,” King said. “They come in one day and say ‘Hey, I got a promotion’ or ‘I got a better job and I have insurance now.’ They come in to say goodbye to the nurses, and that is really heartwarming.”