Margie Gregory says she never has been the type of person to sit around and collect welfare checks. The 55-year-old St. Helena Island woman said she started working at age 16 and worked hard for decades.
But health problems eventually prevented her from holding a job. In 2000, she was diagnosed with Graves disease, an autoimmune disorder that leads to overactivity of the thyroid gland. She had to quit her job as a medical technician at Sterling House on Hilton Head Island. She had COBRA insurance for awhile but to let it go because of the high cost.
With no insurance, Gregory was left in a bind. She could not afford the care she so desperately needed.
"It's sad when you don't have money to pay for a $10 prescription sometimes, and you've got five or six different medicines, and you're juggling from one prescription to the other," she said. "What can I get this time? ... I just didn't have the money to pay."
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Gregory said she would put off going to the doctor because of the cost until things got bad.
She continued to see her doctor at Lowcountry Medical Group in Beaufort because it had a financial-assistance program. But she kept getting sicker and needed to see a specialist.
"A lot of times, if you don't have money and you have all these pre-existing diseases, you can't ... get any coverage," Gregory said. "And that's what threw me in a loop, where I couldn't get the medical help that I wanted, the medical help that I needed. ... (The doctors) don't want to see you if you don't have any money."
Gregory began working again in 2002, caring for a couple of women in their homes on Hilton Head. That didn't provide insurance, but it did help with the cost of medications. It also qualified her for care at Volunteers in Medicine Clinic on Hilton Head. The clinic provides free health care to people who cannot afford it on their own as long as they live or work on Hilton Head or Daufuskie Island.
VIM treated Gregory for Graves disease as well as high blood pressure and diabetes. At the beginning of this past year, Gregory's condition worsened. She said she had painful shortness of breath.
"I couldn't walk from point A to point B without holding onto something," she said. "That clinic was a godsend for me because, I'm telling you, I was almost dead when I came in there."
VIM did what it could for Gregory until it no longer could help her. Then, it set up an appointment for her to go to Beaufort Memorial Hospital, where she had a bone marrow test. Gregory said she was diagnosed with cancer in September. She would not specify what type of cancer she has, but it is being treated at Beaufort Memorial Hospital's Keyserling Cancer Center.
"They never refused to treat me, and that was so amazing," she said of the cancer center, adding that she has paid what she could all along.
Health care across the country
Gregory is one of many people across the country who have struggled to get health care because they can't afford it. And while the nation debates the pros and cons of President Barack Obama's Affordable Care Act, people continue to go without the care they need. Many postpone going to the doctor because they cannot afford it. And when they do go, they often end up in the emergency room because things have gotten so bad.
Hilton Head Regional Health Care president and chief executive officer Mark O'Neil Jr. said the hospital supports the health care reform because of the number of uninsured patients who walk through their doors. The hospital also supported the expansion of Medicaid, but Gov. Nikki Haley opposed it.
O'Neil said the hospital discounts services for patients who do not have insurance, but the costs usually get passed on to people who are insured. The health care reform allows hospitals to be paid more than what they're paid now for emergency services.
Beaufort Memorial Hospital chief financial officer Jeff White said the Affordable Care Act is designed to change the way health care is paid for in the U.S.
"I think it will challenge hospitals and doctors, as well, to maintain a high level of quality and safety while getting paid less for that," White said. "But at the same time, I think we all feel the same concern in that we can't continue to sustain a government-backed health care program that is paying as much as it is, that eventually our country will slide off the cliff. There's no doubt that we have to do something."
VIM executive director Dr. Frank Bowen said what people don't understand about the Affordable Care Act is it will encourage patients to be more health conscious. Under the reform, which is slated to take effect in 2014, he said hospitals will have to establish accountable care organizations that will include wellness centers with fitness prescriptions given to patients.
"We can't continue to take care of our population by just increasing capacity," Bowen said. "Health care is going up at the rate of around 8 percent a year. Ten years from now we're broke."
Instead, Bowen said, we have to decrease demand. With an increasing population, you do that by making sure people are healthier, so they don't develop chronic disease, which is what is so expensive.
"Just because somebody is poor doesn't necessarily mean they can't be well," Bowen said. "But at the same time they may not be able to afford to go to a 'fitness center' because they don't have that extra money in their pocket. So by creating accountable care organizations we will create the ability for them to be able to get their fitness in many different ways."
Bluffton-Jasper County VIM administrator Donna Smith said the idea of everyone having health insurance is great. But she worries about who will provide their care.
She said there are 2,300 people per primary care physician in Jasper County; the national average is 600 people per primary care physician.
"I don't see how you're going to produce all these doctors in all these clinics to care for all these people that would in theory have insurance," Smith said. "We expect to be around. We expect to be expanding services and keep trying to catch the people that fall in the cracks and have no place else to go."
Good Neighbor Medical Clinic executive director Carol Waggoner also worries that there will be not be enough doctors to keep up with the demand. The Lady's Island clinic serves patients who have no health insurance.
"I see our clinic as being available and meeting a need, no matter what happens with health care legislation," Waggoner said. "We're not going to go away, and we're going to depend on the generosity in the community. There's always going to be a need no matter what happens."
Gregory suggests that people who don't have insurance call around to find out what is available. She thought VIM was only available for residents of Hilton Head. If she hadn't found out it was also an option for people who work on the island, she might never have gotten the care she needed.
"You've got to ask questions," she said. "A lot of places don't advertise where you can go if you need help. ... If I didn't (find VIM), I think I would've been dead now."