Finding Health Care in the Suburbs When You’re Poor

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  • January 28, 2014
LakewoodGarrPhotoLakewood, a suburb of Cleveland, OH

By Barbara Ray

“There is a new group of people who don’t know where to go for help. They are newly poor and don’t know what to do.”

That quote, in Scott Allard and Benjamin Roth’s 2010 report on the social service challenges posed by suburban poverty, still rings true today, as millions of Americans  continue to struggle to regain lost ground after the recession. Many of them are newly poor and find themselves invisible in the suburbs.

Take for example, Christine Shearheart, a Cleveland area resident who was laid off in June 2010. She found herself turning to North Coast Health Ministry (NCHM), a free health clinic in suburban Lakewood serving low-income families and individuals.

“I knew I didn’t have health care and I knew I couldn’t afford it living on unemployment,” she said in a video on NCHM’s website. “There’s so many people in my position that aren’t old enough to be on Medicare but are without any health care whatsoever, and there’s a gap that needs to be filled.”

Lee Elmore, executive director of NCHM, remarked that “even with Medicaid expansion, we expect there to be over 70,000 uninsured individuals in Cuyahoga County in 2014. We are seeing more people who are uninsured and without a job for the first time in their lives. They don’t have any experience with the social service safety net and need help finding resources.” They are also deeply embarrassed, he wrote.

NCHM is a lifeline for these families, but it is one of only a handful of social service providers located in Cleveland’s suburbs. The growing number of low-income residents outside of Cleveland—who now account for 56 percent of the metro area’s poor population—must often travel downtown for medical care and other essential services. Yet, as Elmore noted, “as public transportation has become more limited in some portions of the Cleveland metro area, getting to these other providers of care can be quite challenging for many who reside outside of the central city.”

NCHM is also struggling with another issue: capacity. Not being a federally-subsidized clinic, it’s funded largely by foundations. But as other agencies that previously relied on government funding find that source drying up, they too are turning to local foundations. “The competition for funding from our longtime foundation partners has never been greater,” Elmore said. Limited funding means they can staff only one full-time physician and nurse practitioner, even as demand rises.

By investing in the expansion of Consolidated Health Centers, the implementation of the Affordable Care Act (ACA) presents an opportunity to address these service gaps, not just by increasing health care coverage of low-income residents, but also by helping to grow health care capacity in underserved communities. These new dollars represent an important infusion of funds into struggling places. But the question remains: to what extent will these capacity building efforts target hard-hit suburbs like Lakewood? (So far for Cleveland’s suburbs it hasn’t. The last round of funding for new access points invested in the city of Cleveland, but not in the suburbs. The latest round of funds has not yet been awarded.)

Without waiting for Washington, communities in suburban Chicago are finding ways to improve access to health care through a novel partnership. For years, the DuPage Community Clinic was the only free health clinic in the 337-square-mile suburban DuPage County. In 2011, it joined with Access DuPage to expand its reach. As a collaboration of hospitals, physicians, local governments, human services agencies, and community groups, its network includes more than 100 private physicians’ offices and four federally qualified health clinics. It enrolls about 14,000 low-income DuPage residents annually, according to a recent report.

That approach seems to be having an impact, as a recent evaluation finds. One of the authors, Melissa Simon, M.D., told the Northwestern University news team:

The dramatic demographic change that suburban counties are experiencing exacerbates the lack of a health care safety net.…traditionally located in urban centers. Creative solutions are required to expand access and improve medical care for high risk, medically underserved populations. Such creativity pivots on successful partnerships between community-based organizations, public health institutions and academic medical centers.

More of this creative thinking is clearly needed to make sure the safety net is stretching to meet the health needs of an increasingly suburban underserved population.

Photo/Chris Garr

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