'This really is a miracle': How nontraditional methods help uninsured get health care

It had been more than a decade since Armando Hernandez had last seen a dentist.

“I live on Social Security and I'm retired, so I don't have insurance, and things just add up and I don't go,” the Elgin man said.

He stayed away, even with a recent toothache, until he heard about a free pop-up health clinic last weekend. There, he found relief. And it did not cost him a thing.

Hernandez was one of 424 patients treated at a two-day clinic at Judson University's Lindner Fitness Center in Elgin coordinated by the Heal Elgin Project and Remote Area Medical Volunteer Corps.

The fitness center was transformed with 30 dental care tents atop the basketball court, a room where a dozen eye exams could be conducted simultaneously, private medical examination rooms, tables filled with free ready-to-wear eyeglasses and a mobile lens design lab parked outside.

The clinic is one of the many ways organizations and health care workers are teaming up to assist uninsured or underinsured Americans who can't access care otherwise.

Sharon Lane is one of those people. The Elgin woman, who has diabetes, said she'd been having a harder time seeing clearly over the past couple of years and hadn't been to an eye doctor because of her fear of contracting COVID-19 and the out-of-pocket costs she would have incurred since she doesn't have insurance that covers vision care.

“This really is a miracle,” she said. “On the spot, you see better.”

Lane's plight is not uncommon. Equity and access are major issues for all facets of the health care industry, but they have largely escaped greater scrutiny until now.

“The issue has been around a long time, but COVID and the impact of COVID really brought it to the fore and forced people to pay attention to it,” said Jim Parker, director of the Office of Medicaid Innovation and Policy at the University of Illinois.

Last weekend's free clinic in Elgin had been in the works even before the pandemic; it actually was canceled last year because of it. But as organizers note, the need never went away. Likely, it increased.

Heal Elgin officials said this is the largest crowd they've had for a clinic.

Despite a greater push to provide all Americans with health insurance of some kind through the Affordable Care Act, an estimated 30 million Americans are still without insurance, the single-largest barrier to receiving care, experts agree.

Of those uninsured, somewhere between 600,000 and 1 million live in Illinois, based on estimates from the Illinois Department of Healthcare & Family Services and industry watchdog groups.

In addition, a 2019 report by The Commonwealth Fund, a research group promoting universal health care, showed 28% of U.S. adults with insurance through an employer “have health plans that fail to adequately protect them from health care costs.”

“There are multiple barriers if you peel back to even someone who's employed,” said Jeff Eastman, CEO of Remote Area Medical, the group that provided logistical support, volunteer training and equipment for the Elgin clinic. “The system is complicated to begin, but we ask 'where does it hurt,' and that's it. We're a network for everybody.”

Planning partnerships

The Heal Elgin Project started out as something far less ambitious than it is today.

Dr. Terri Dallas-Prunskis was along the banks of the Fox River several years ago waiting on an Elgin city official to map out a path for a 5K fun run. She was planning the event through Elgin Adventist Church as a fundraiser for a child nutrition program.

She heard rustling in the bushes, and then a sneeze.

“I just ran!” She recalled. “And then I saw these kids come out of the brush, and they were carrying their belongings with them.”

Together with the church's pastor, Gabriel Bardan, and another church elder, Eric Fulbright, Dallas-Prunskis decided there was a much greater community need than just an annual fundraiser.

“We had been involved with nutrition and hunger, and now we were dealing with issues of homelessness, and I saw that a component we were missing was the health aspect and wanted to do something about that,” said Dallas-Prunskis, who is an interventional pain physician.

Heal Elgin immediately outgrew its first clinic in 2018 held at the church, drawing many more than organizers anticipated.

“I remember people would come outside after being treated and pull out their phones and call someone to tell them excitedly that it was real,” Bardan said.

The clinic was moved to a park pavilion the next year, but again it needed more space. The program then partnered with Remote Area Medical for the third clinic to broaden the level of care, so Bardan reached out to Judson University leaders, who offered up the school's field house.

In addition to securing a location, Heal Elgin finds volunteers to staff registration and perform other on-site tasks and then gets local health care workers to volunteer their time.

“This is our purpose now, to become the middle man for those in need and those health care resources,” Bardan said.

And it's these types of programs and partnerships that public health officials believe will bridge gaps in access to care and equity of medical service.

“It's this notion of trusted partners in the community,” said Kim McCullough-Starks, deputy director of the Illinois Department of Healthcare & Family Services. “We know that people will listen to the people they trust when it comes to their health, and when someone they know is pointing them into the right place to get that access to care.”

That has been the consistent plea from public health officials throughout the pandemic. When vaccines became available, state officials placed an emphasis on providing vaccination sites for those who might normally struggle to access health care opportunities.

Illinois Department of Public Health Director Ngozi Ezike made a point of partnering with church leaders to provide assistance in vaccination uptake among hesitant populations. IDPH frequently dispatched mobile vaccination clinics to churches throughout the state, all in an effort to provide greater access to underserved communities.

“As much as rapidity is important, equity is important,” Ezike said during a congressional hearing last February. “Rapidity without equity will result in continued disparity.”

Hospital health

Illinois is home to 21 “safety net” hospitals. While most are in Chicago, Amita-Adventist Glen Oaks Medical Center in Glendale Heights and Presence Mercy Medical Center in Aurora are also among that group.

Safety net hospitals are defined as having at least 50% of inpatient hospitalizations paid for by Medicaid, the state's taxpayer-funded medical assistance program.

In 2020, IDHFS reported that 3,055,055 residents received comprehensive health care benefits from Medicaid. Another 46,984 received partial benefits. That's about a quarter of the state's population.

“Safety net hospitals have a very important role to play but are not the only ones needed to assist in that space, because a lot of the health disparities are not simply someone needing an inpatient hospital stay,” said Ben Winick, IDHFS chief of staff. “If someone needs an inpatient hospital stay, we're already at an outcome we're not seeking to begin with.”

Hospital officials in Illinois say they are working to reduce barriers to health care access, particularly in preventive medicine so that the need for hospital stays is reduced.

“There is no one thing that is going to solve everything, no silver bullet solution,” said Danny Chun, a spokesman for the Illinois Health and Hospital Association. “Hospitals are getting together with community-based organizations and other local partners to ask what they can do to improve equity and access.”

When Edward-Elmhurst Health and NorthShore University HealthSystem announced plans to merge recently, one of the centerpieces of the announcement was a $200 million commitment to create an investment fund to pay for programs and initiatives that boost access and equity in the communities served by their combined nine hospitals.

“All of this is in service of our overall quest for optimal health in every community,” said Jordan Powell, senior vice president of health policy and finance for the hospital association.

Meanwhile, Heal Elgin's latest endeavor is a church-based “lifestyle center” aimed at changing nutritional and fitness behaviors that lead to medical intervention or hospitalizations.

“Most degenerative diseases are related to lifestyle,” Bardan said. “This is our future.”