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Coalition of Clinics Gives Hope to Uninsured

Montgomery Ponders Investment Needed to Expand Venture, Reach More Adults

By Cameron W. Barr
Washington Post Staff Writer
Tuesday, August 24, 2004; Page A01

They came to a church basement in Silver Spring to celebrate health care for the uninsured in Montgomery County: West African women in neon-bright cotton prints; robed and collared clergy from Bangladesh, Canada and Vietnam; business-suited doctors and elected officials.

Community organizer Jean-Bernard Neim, originally from Cameroon, beamed at the crowd assembled at Our Lady of Vietnam Church that afternoon in June. "It's a day we never thought would come," he said. "The opening of . . . the very first pan-African, Haitian clinic in the greater Washington area."


Alvina Long is director of Mercy Health Clinic, which has more than 1,100 patients a year and two full-time staff members. (Lucian Perkins -- The Washington Post)

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A choir of a dozen men and women, representing nine African nations and Haiti, took the stage. "It's marvelous, really marvelous," they sang in French, clapping and swaying and bringing the audience to its feet.

The pan-African clinic is part of a network of 10 independent, nonprofit health clinics that county leaders hope will expand and become a de facto system of universal health care in Montgomery. An initiative that started five years ago with a $100,000 county grant to promote primary health care for uninsured adults has grown into a $2.1 million annual investment.

Health care advocates, politicians and public-health officials -- prodded by County Council member George L. Leventhal (D-At Large) -- are now considering how to extend primary care to all low-income, uninsured adults in Montgomery, including undocumented immigrants.

There are a variety of state and federal programs for children, the elderly and pregnant women. But as the costs of health care and insurance have risen, adults have emerged as the group most in need. The clinics already provide primary care to more than 11,400 adults a year, out of the 80,000 to 100,000 people thought to be uninsured in this county of nearly a million.

Without state or federal solutions to the plight of the uninsured, about 600 local jurisdictions have assembled some form of low-cost coverage or access program the past decade or so.

Few, if any, have embraced the goal of universal care. Under a plan endorsed by Leventhal, county residents earning less than 250 percent of the federal poverty level -- $47,125 a year for a family of four -- would be eligible. This relatively low threshold "is a bolder step than most states or counties have ever undertaken," says Diane Rowland, a health policy expert at the Henry J. Kaiser Family Foundation in Washington.

The expansion would cost Montgomery an additional $20 million a year, a nearly tenfold increase in the $2.1 million it spends to provide primary care to uninsured adults. "We're asking the question," Leventhal said, "can we really do this for everyone?"

If any Maryland jurisdiction can, perhaps it is Montgomery, the state's most populous county and one of its richest, endowed also with an unusually large community of medical professionals, attributable in part to the presence of the National Institutes of Health in Bethesda.

"No one else does anything as elaborate as we do," Leventhal said.

County Executive Douglas M. Duncan (D) and his administration are responding with what may best be described as grudging support. "We're doing what we can in the absence of the others doing what they should," he said. Still, Duncan said, there will be more money for the program in next year's budget.

Apart from money is the question of whether the county should become a primary-care provider. "The goal is not to have the county carry the burden," said Ulder Tillman, Montgomery's health officer. "We've got to avoid going into a black hole."

The system under construction in Montgomery is a collaboration between community groups, nonprofit clinics, volunteers and the county government. It focuses on providing primary care and medication, leaving aside specialty care, mental health treatment, dental care and hospitalization in favor of addressing basic needs.


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