Healthy Choices and Health Equity

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Tompkins Weekly 5-19-14

By Abbe Lyons

Eat right. Exercise. Get enough sleep. Learn stress management skills. Know when to call your health care provider. Personal actions like these are often seen as the key to good health. It’s undeniable that there are many things we can each do individually, every day, to improve our health and well-being. And with all the press about health insurance lately, you might come away with the impression that if only everyone would enroll in a health insurance plan, all our health care needs would be taken care of. Given our current system, having health insurance is better than being uninsured, but health insurance by itself does not equal health care. There are many factors that affect whether we can get healthy and stay healthy, some of which are not in the realm of personal choices.

Our health depends on the health of our environment, and is affected by the inequities in our economy and our society. Structural racism, income inequality and other disparities can have a significant impact on whether we have access to safe working conditions, affordable healthy food, adequate housing, and appropriate health care; on how vulnerable our neighborhood is to pollution; and whether we can afford the out of pocket costs for our health care, even if we have health insurance. Have you or someone you know ever put off the care your doctor or dentist recommended because of the deductible or the co-pay? Health insurance does not by itself guarantee easy access to health care. With a relatively high median income and many strong efforts toward a healthy community, Tompkins County’s overall health outcomes are high, yet there are still many individuals with all levels of education and health literacy, particularly among the working poor, who fall through the cracks. Our county is ranked low in terms of affordability, particularly with housing costs, and for those whose income is below the county median, it’s hard to afford the essentials of rent, heat, and food. Adding the costs of health insurance premiums, co-pays and deductibles makes it even harder.

The Ithaca Health Alliance was founded to make a difference for those of us who find ourselves faced with “choices” such as deciding whether to pay the rent or refill a prescription. Our very first program, Ithaca Health Fund, began to address these challenges by providing financial assistance for specific categories of care to low income local residents, reducing or preventing medical debt. Today, the Health Fund continues to help people in our local community who can’t afford the cost of health care. Anyone whose income falls below 80% of the Tompkins County median income, and lives in Tompkins or one of the six surrounding counties, can apply for a Treatment Grant towards the cost of care in any one of these six categories: broken bones, emergency stitches, tooth extraction, root canal, post-exposure rabies inoculation, and Chinese herbal medicine for serious, chronic or terminal conditions. For one applicant, finding out that there was a Treatment Grant available for a long-delayed root canal made the difference in going ahead and getting the care she needed. For another, a Treatment Grant made the difference in being able to get a much-needed set of dentures. A Treatment Grant helped a cancer patient who could not afford his acupuncturist’s prescription for Chinese Herbal Medicine, and the herbs made such a big difference for him.

In 2013, Ithaca Health Fund added a Financial Advocate volunteer program, and advocates helped forty one people apply to various financial assistance programs, including hospital charitable care programs, prescription assistance programs, and, of course, Health Fund Treatment Grants. Their health care needs ranged from drugs for for diabetes and epilepsy, to surgeries, to treatment for a heart attack. One person, who had had emergency stitches, called about applying for a Treatment Grant, only to discover he was eligible for another financial assistance program which covered the entire cost. He didn’t end up needing the Treatment Grant, but without that point of entry, he would likely have ended up in financial trouble. This year we have expanded our advocacy program to help people look at other benefit programs they might be eligible for. When paying for food, heat, rent, or telephone service takes a smaller bite out of your pocketbook, you’re more likely to feel that your prescriptions, medical transportation, out of pocket health care costs might not be so far out of reach. You might be able to afford the co-pay for a doctor’s visit. You might be able to afford to eat more fruits and vegetables.

At the Building Bridges Community Forum on May 13, it was clear that although there is amazing work going on in Tompkins County, we as a community still need to make changes. Let’s work together create the conditions under which healthy personal choices can be truly available to everyone.

Abbe Lyons is the Executive Director of the Ithaca Health Alliance.

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