We live in parallel universes.
For the vast majority of Rhode Islanders — the insured — health-care is something you get when you need it. Feeling sick? Call the doctor. Slip and fall? Go to the emergency room or an urgent-care center. Need surgery? It's not fun, but it's covered.
But for more than 100,000 uninsured Ocean Staters, seeing a doctor can cost $150 or more, an ER visit can easily top $1000, and a hospitalization can lead to bankruptcy.
And now unemployment is swelling the ranks of the uninsured: a record 50,200 Rhode Islanders collected unemployment in September, and the state's unemployment rate has risen to 8.8 percent. Simultaneously, the state has cut RIte Care, its Medicaid program for families, to help close a major deficit, leaving thousands of poor children and families without coverage.
"Over half of the adults who are coming in now as new patients don't have insurance," says Merrill Thomas, CEO of the Providence Community Health Centers, which serve more than 35,000 mostly low- and middle-income people. "It's a bad spiral downward."
So if you're uninsured and need health-care, what do you do? Here are some options.
COMMUNITY HEALTH CENTERS
Much as Thomas and his statewide counterparts worry about the growing wave of uninsured patients, they are there to help everyone who needs them — it's their mission.
Community health centers provide comprehensive primary care to anyone who comes in, and offer a charge based on one's income: a $20 minimum if you meet federal poverty guidelines, or gradually more, up to fees comparable to a doctor's office, if you're fairly well-off. "The poverty guidelines aren't as stringent," Thomas says. "If you're a student and you're making $10,000 a year, you're going to qualify."
The centers also help patients get specialty care, medications, and, if needed, hospital care, and connect them with programs for which they might be eligible, from RIte Care (which remains a great safety net for pregnant women and children) to drug assistance programs.
Rhode Island has 12 community health centers, some with multiple locations — from Woonsocket, to Coventry, to Block Island — with a concentration in urban areas. Each has a different range of services and fee scales; to find one near you, visit rihca.org.
THE RHODE ISLAND FREE CLINIC
Can't afford to pay anything for health-care? The Rhode Island Free Clinic, in Providence, is there for you. Just be warned, though, it may be hard to get in — because the clinic can only care for about 1000 of the estimated 35,000 people eligible for its services.
Accepted patients are cared for by doctors who volunteer for afternoon and evening clinics, including Brown University medical residents and well-respected local physicians. The clinic provides primary care and a limited range of specialized services, but also helps patients get specialty and hospital care, medications and anything else they need.
A new "virtual clinic" is now under development to recruit doctors statewide who can take a few uninsured patients free of charge, a move expected to dramatically increase the clinic's capacity. For more information, go rifreeclinic.org.
The most affordable option for all but the poorest uninsured is a year-old program started by Dr. Michael Fine, the primary care physician and health-care visionary who years ago created the Scituate Health Alliance to provide affordable care to everyone in that town.