Two years ago, Katherin Blanken found that she couldn't get from the bedroom to the bathroom without falling on her face. Her legs kept giving out. She went to Mercy, where volunteer doctors ordered a CAT scan and other tests.
A lifelong county resident and uninsured since her marriage broke apart in 1996, Blanken has spent time in homeless shelters. Mercy workers did not charge her.
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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Tests revealed a blockage in her abdominal aorta, the main artery that ferries blood from the heart to the lower body. Without surgery, vascular specialist Robert Fox warned her, Blanken might lose her legs. He corrected the blockage in a four-hour operation at Shady Grove Adventist Hospital in August 2003. The hospital provided the care pro bono.
Today, Blanken, 33, is back on her feet, although she cannot work because of health problems. Yet without Mercy, she said, her condition "would probably have progressed to the point where I would have died."
Her experience illustrates another key component of Montgomery's emerging health care network: It relies on nonprofit clinics and volunteers.
Mercy, for example, sees more than 1,100 patients a year but has only two full-time staff members. In 2003, it had an operating budget of $249,900 and received $689,097 in donated services, roughly half in the form of volunteer time.
Montgomery's wealth of volunteer medical professionals -- bolstered by the presence of the National Institutes of Health -- is one reason why the county's system of health care for the uninsured would be difficult to replicate elsewhere. "I'm not sure I could come up with a more responsive environment," Galen said.
In 1999, Duncan assembled a package of programs intended to benefit the working poor. It included a $100,000 grant to the Primary Care Coalition for research into making health care available to uninsured working adults.
That seed money, together with foundation grants and the work of the clinics, was a key step toward the system that exists today. Like many politicians across the county, Duncan addressed the issue reluctantly. But the reality, he said, is that "we've got people who have shown up at our doorstep every day with health issues."
Five years after Duncan began the "Rewarding Work" initiative, the county is spending at least $2.1 million to support the coalition and nonprofit clinics. That amount doesn't include other county contributions, such as office space for clinics and malpractice insurance for volunteer staff.
The figure does include two programs that the council, with Duncan's support, funded just this year: $350,000 for a community pharmacy that stocks the clinics with medications and $100,000 to create an electronic database of patient records that would be available to clinics in the network.
Other county health programs, with a combined budget of about $23 million, also treat the uninsured, but they are not focused on providing primary care to adults.
Last year, Leventhal, who chairs the County Council's health and human services committee, asked Galen to propose a way to reach all the uninsured people in the county. Experts assume that half of any given population of uninsured won't take advantage of available services, so Galen estimated Montgomery's target group to be 40,000.
Galen led a committee that developed a proposal called "Montgomery Cares" and calculated that providing primary care and medicine to that population would cost the county $15 million a year. County health officials said annual implementation costs would come to $4.7 million, for a total of nearly $20 million.
The county budget for this fiscal year is about $3.3 billion; nearly $206 million will fund the department of health and human services.
Montgomery's nonprofit clinics also will have to increase the amounts of money they raise and the volunteer help they solicit to implement Montgomery Cares.
In spring 2005, it will be up to Duncan and the council to decide how much to spend to continue building toward universal care. Leventhal envisions achieving full implementation over several years. "I will strive and I will succeed in increasing the funding every year," he said.
