Providing Care for Uninsured More Daunting Than Expected

When clinics tackle one problem, another pops up. In June, Mercy Health Clinic moved into a new space in a Gaithersburg county building twice the size of its previous home in Germantown. But because the clinic depends on volunteer doctors and nurses, it's only open three days a week. Clinic Administrator Amra Slakovic-McClanen would love to open the doors Mondays and Fridays, but finding doctors and nurses willing to volunteer time on those days is a challenge, she said.

By contrast, Proyecto Salud, a clinic in Wheaton, could easily fill that space and more with its current patient load, Executive Director Cesar Palacios said.

On a recent weekday morning, clients spilled out the clinic's front doors. Last year, physicians and nurses here saw about 3,000 patients at the site across from the Westfield Shoppingtown Wheaton mall, Palacios said. The clinic expanded its hours twice last year, staying open until 8 p.m. instead of 5 p.m. five days a week. It added Saturday hours twice a month.

Guadalupe Berger, 53, of Silver Spring said the medical staff at Proyecto has helped her manage her diabetes and enables her to afford the medications she needs. Berger works as a home health care aide but said not all the companies she works for offer health care coverage. She said she can't afford to buy private health insurance.

"This is a very good clinic,'' she said. "The people are very caring and very nice. I wish there were more clinics like this.''

Montgomery is among a growing number of counties and states that are establishing partnerships to care for the uninsured. Anne Arundel and Fairfax counties both have initiatives in place.

According to the Henry J. Kaiser Family Foundation, 46.5 million non-elderly Americans lack health insurance. Between 2005 and 2006, the number of uninsured increased by 2.1 million.

In Maryland, about 800,000 residents are uninsured. Last November, Gov. Martin O'Malley (D) launched a program to expand coverage to 140,000 people by expanding Medicaid and offering subsidies to small businesses. But absent larger efforts at the state and federal levels, it has fallen to counties to fill the void.

"There is a fundamental problem in that the buck has to stop somewhere,'' said Robert Friedland, an associate professor of health systems administration at Georgetown University School of Nursing and Health Studies, about why states and counties have established programs.

Montgomery officials say they don't know when they'll reach their 40,000 patient target.

"We're getting close to that tipping point,'' Galen said. "In the next two or three years, if we can get ourselves [to the point where] clinics can see 3,000 to 4,000 patients and we add a couple of clinics, we really [can] increase the capacity.''

Ahluwalia urged patience, saying creating a program to care for the uninsured "is a little like laying the train tracks as the train's coming toward you.''