Ella Whitfield: Health care for all is a win-win for all

April 27, 2024. The Daily Reflector. By Ella Whitfield.

Ella Whitfield

Ella Whitfield, 2023-24 NC Schweitzer Fellow

The patient felt hopeless by the time he arrived at the free clinic where I volunteer. His diabetes was dangerously out of control, with a blood sugar reading twice the normal level, and it was beginning to affect his vision. If it got worse, he feared, soon he wouldn’t be able to see his grandchildren’s faces.

It’s difficult to imagine a consequence so tragic stemming from an eminently manageable disease. But the story of this patient — I’ll call him Bill to protect his privacy — is one that plays out every day in eastern North Carolina and across our nation.

Hundreds of thousands of North Carolinians live a precarious existence with no health insurance coverage of any kind, in many cases suffering from unmanaged chronic diseases like diabetes, high blood pressure and hypertension and unable to afford the most basic medical care.

Some, like Bill, had things good for a while — a construction job that paid a living wage and provided health insurance. He lost both when he was laid off during COVID and cut back on his medication as he struggled with skyrocketing food and rent costs. Others have spent their entire adult lives uninsured.

As a third-year medical student at ECU and volunteer at Pitt County Care Clinic in Greenville, I see the human, economic and societal toll exacted by lack of access to ongoing, preventative health care. Doing more to provide every North Carolinian the health care they need would be a win-win for all.

The costs are real and borne by our entire community. Sick people who don’t have insurance wind up in the emergency room, incurring unaffordable bills about 15 times higher than the cost of a primary care visit and raising overall health care costs.

Worse, chronic diseases left unmanaged lead to much more serious and expensive health complications. Untreated diabetes can result in bone infections requiring limb amputation, a $70,000 procedure compared to the nominal cost of helping a patient manage their diabetes daily.

Most of North Carolina’s uninsured are employed, so providing them with access to health care helps them stay healthy and productive so they can continue to support their families and contribute to their communities.

Pitt County Care Clinic and nearly 70 others statewide provide quality health care to the uninsured regardless of ability to pay. Data shows we are improving health outcomes for our most vulnerable neighbors while saving the health care system $360 million annually by keeping the uninsured out of ERs.

Bill got the help he needed — a personalized treatment plan, a self-care kit to monitor his blood sugar, access to free medications and information about where to get help with his rent. He left hopeful for his health and his chances of seeing his grandchildren’s faces for years to come.

But the needs of North Carolina’s uninsured are growing as the cost of living and health care in particular climbs inexorably. Even after Medicaid expansion is fully implemented, hundreds of thousands will remain uninsured.

Many of those don’t qualify because they exceed Medicaid’s income threshold, but many uninsured are undocumented immigrants who aren’t eligible for Medicaid no matter what they earn.

About half of our patients are immigrants, understandably given the importance of migrant workers to our region’s economy. I don’t know how many are undocumented because we don’t ask. We simply do our best to provide quality care for all who show up at our doors.

Our vision of providing all people equitable access to quality health care regardless of ability to pay means just that — all people, whether they were born in Pitt County or came from another country, legally or otherwise.

It’s a vision I hope all North Carolinians can embrace.

Ella Whtifield, a student at ECU’s Brody School of Medicine and an N.C. Schweitzer Fellow, is co-executive director of student-run Pitt County Care Clinic, a free medical clinic in Greenville.