Tillicum clinic to close June 1
JORDAN SCHRADER; Staff writer
Government insurance paid for two-thirds of the patients seen by the Tillicum Family Medical Clinic last year. Public money also helped cover the more than one in five patients who came to the clinic with no insurance at all.
Some of that money is going away. On June 1, so will the clinic.
The latest of several clinic closures in recent years by Pierce County’s Community Health Care will move a staff that has built relationships with patients like Marcela Tovar, who can count on them to speak to her in the Spanish that she and about 7 percent of clinic patients prefer. Like many residents of Lakewood’s Tillicum and
Woodbrook neighborhoods, she and her children will no longer be able to walk from home, as they did Wednesday after 2-year-old Kevin came down with a cough and fever.
“It will be more difficult for me, because I only have one car,” Tovar said. “The car is for my husband for work.”
Community Health Care plans to close the smallest of its six sites as state budget cuts force tough decisions for the 26 nonprofit community health centers that are the administrators of much of the state and federal medical safety net.
Another health center with four locations in Thurston County and three in Pierce, Sea Mar, has no plans to close any of them, at least until a state budget is written.
In Tillicum, Dr. Jeff Smith predicts most patients will follow him to the Lakewood clinic, but others worry some patients in the isolated neighborhood will slip through the cracks.
And it’s not just a question of geography. The state’s community health centers operate under federal requirements to treat all patients – charging them on a sliding scale based on their ability to pay – but that mission is threatened.
Community Health Care isn’t kicking out uninsured patients, but it is stopping newcomers at the door. There are no appointments available for the foreseeable future for the uninsured, CEO David Flentge said.
“We’re just not able to bring new uninsured people into our system,” said Flentge, who added that the Pierce County system’s 35,000 patients might drop by 4,000.
Community Health Care has laid off 20 people from a staff of more than 300 since Feb. 1, including a dentist and two dental hygienists. It plans to close its smallest pharmacy, in Spanaway, June 1.
BUDGET CUT THREATS
Other health centers have threatened to close locations too, but are waiting to see what lawmakers do with Gov. Chris Gregoire’s proposed budget. They say they face a combined $590 million hit under Gregoire’s plan, which the statewide Community Health Network of Washington describes as about 20 percent of the centers’ total budgets.
The cuts include a lower rate paid for treating patients under Medicaid, the federal-state health insurance program, and the potential elimination of the Basic Health Plan and Disability Lifeline, two state programs aimed at patients who are poor but don’t qualify for Medicaid.
The Legislature has already shrunk the Basic Health Plan to a third of its former size. In Pierce County, Community Health Care lost most of its 3,000 Basic Health patients when budget cuts raised the eligibility level and made them no longer poor enough to qualify. Then the remaining group was cut in half March 1 when some 400 patients failed to meet a new requirement to produce a Social Security number.
But don’t count the health centers out. With more than 150 locations statewide, key budget writers in both parties see them as important pillars in the health care system.
And they have more lobbying muscle than most interests in Olympia.
Lobbying spending reported in 2010 by the Community Health Network – $705,000 – ranked it behind only four of Olympia’s heaviest hitters: the Building Industry Association of Washington and affiliates of three of the country’s biggest public-employee unions.
That total includes political donations that made the network the biggest contributor to the House and Senate Democrats’ campaign committees, after some of the unions chose not to give directly to the committees last year.
The centers have grown by more than two-thirds since 2001 to serve more than 730,000 patients – one in 10 state residents.
Sea Mar opened its Lacey clinic last May. “Although the budget continues to get worse,” said Shanon Hardie, vice president of operations, “the demand continues to grow.”
One reason for the growth is the insurance plan set up by the network of centers, which now covers nearly all temporarily disabled people under Disability Lifeline, much of the state’s Medicaid managed-care population of mainly kids and pregnant women, and patients on other state programs.
In some ways, the centers’ growth makes them vulnerable. If Basic Health and Disability Lifeline disappear, the patients become uninsured but aren’t going anywhere. The clinics will have to keep treating them.
Rep. Bill Hinkle, R-Cle Elum, wonders if the state was smart to pump up the clinics.
“You go to some of these clinics I’ve visited, and they have doubled or tripled in size, and it’s all built around a system that is on shaky ground financially,” Hinkle said. “As their caseload grew, they grew. Now we’re at the point where we can’t sustain the reimbursement rates for them. We don’t have the money to keep the insurance programs going that government has put together.”
House Republicans have called for eliminating Basic Health and Disability Lifeline. Rep. Gary Alexander, R-Thurston County, said the state can’t afford them because they don’t serve the most vulnerable, unlike Medicaid, Medicare and a program for people waiting for federal disability benefits. But he says the Legislature needs to find a way to keep patients in the clinics.
House Democrats, who could unveil a proposal as early as this week for dealing with the $5.3 billion budget shortfall, hope to keep both threatened programs. Budget vice-chairwoman Rep. Jeannie Darneille, D-Tacoma, said she has been working on a plan to save the medical portion of Disability Lifeline and redefine the program, which also provides $174-per-month cash grants, to focus on providing access to housing rather than cash.
Democrats see both programs as a bridge to the implementation of the federal health care law.
In 2014, if the law survives legal challenge, the federal government will start paying for the care of all the patients now in the programs, said Rep. Eileen Cody, D-Seattle.
If clinics close, Hardie said: “A couple years from now, even if you give them insurance they’re not going to have any place to go.”
The centers are most worried about the Medicaid rate, which the Legislature has already reduced and Gregoire proposes to continue at a lower level. They say they are losing money on every Medicaid patient they treat, which would be a violation of federal law by the state. But members of the Legislature dispute the centers’ numbers.
Cody, the House health committee chairwoman, said House Democrats are looking for a level between the current rate and the old, more generous one.
At the Tillicum clinic, which Flentge says is losing $150,000 a year, patients stand to lose their “safe haven,” said Karen Priest.
Priest runs the community center that leases space to the clinic. She is trying to recruit another health care facility to replace it, while questioning the closure in the high-poverty neighborhood.
“Why Tillicum?” she said. “I mean, we’re already such a hard-hit area, and these residents are already down and out.”
Jordan Schrader: 360-786-1826