By Emily Kruse, University of Notre Dame (2016)
As a Medical Administrator Intern at CrossOver Ministry, a free healthcare clinic in downtown Richmond, Virginia, I experienced, learned about, and assisted with many unique aspects of providing healthcare to poor and uninsured residents. Inadequate healthcare access in the context of poverty is complex and multifaceted; it cannot be resolved or even understood in one summer of service, in one poverty awareness class taught at a university, or from the volunteer efforts of one physician at a rural clinic. Taken in isolation, these learning opportunities seem relatively minor, yet taken together they play a vital role in the cohesive synergism of healthcare delivery to impoverished persons. CrossOver Ministry sets an exceptionally high standard of quality and character in medicine that optimistic prospective providers would imagine as the ideal model of care for the uninsured. Unfortunately, free clinics must stretch limited resources and may not ultimately be to sustainable models of care in low-income communities. Instead, the United States absolutely must identify and implement the most comprehensive, cohesive, affordable, and accessible model of care to ensure continuous care for each resident.
CrossOver Ministry serves over 8,000 patients at any given time, employing several staff doctors and nurses along with numerous volunteer providers. While a few providers work daily, most work one or two shifts per week or per month. Patient-provider interactions are frequent and thorough, and CrossOver acts as a safe haven and center for overall wellness for the majority of patients. Between CrossOver’s two clinics in the Richmond area, a wide range of services are made available to patients: primary care, specialty care, outside imaging and procedure referrals, Access Now referrals (a program that allows patients to visit specialists out of CrossOver’s network), pharmacy services, laboratory testing, dental services, counseling and other mental health services, pharmaceuticals and counseling for HIV-positive patients, and social work services. If CrossOver cannot provide a service for a patient, the team finds alternative access to necessary care. The volunteers and staff at CrossOver Ministry display true empathy and commitment to compassionate care.
I began my internship as a front office volunteer, which entailed checking patients in for their appointments, scheduling upcoming appointments, aiding in communications between clinical staff and front office staff, answering phone calls, filing patient documents, faxing documents, and attending to the needs and inquiries of patients who approached the front window. I thoroughly appreciated this opportunity to interact with patients throughout the day and to develop relationships with many of them. A substantial percentage of CrossOver patients speak Spanish, so I was able to improve my conversational Spanish skills. Several weeks into my internship, I began and completed a medical records cataloguing project. I conducted financial screenings for prospective patients, managed obstetrics scheduling, and performed scribe duties for various specialty physicians. I learned that the volunteers and staff at the clinic manage distinctive sets of logistics smoothly as a coordinated unit that meets and resolves new challenges.
Through its system, CrossOver serves poor residents in Virginia who face particularly difficult obstacles to care. Only children and pregnant women at or below 143 percent of the federal poverty line qualify for Medicaid, while people age 65 and older who are at or below 120-135 percent of the federal poverty line as well as some qualified patients with disabilities and end-stage renal disease qualify for all of the benefits of Medicare. Several other programs and resources like Planned Parenthood and Virginia Coordinated Care through Virginia Commonwealth University fill in minor gaps for some residents, but a massive portion of poor persons in Virginia remain uninsured. CrossOver serves this unique population of uninsured patients desperately in need of adequate care. Importantly, the expanded coverage of the Healthcare Marketplace under the Affordable Care Act seems to have decreased donations and grants to CrossOver Ministry because donors wrongly assume that public coverage under the ACA met the needs of most CrossOver patients. In reality, many of CrossOver’s patients are undocumented citizens seeking refuge from unlivable conditions in many Latin American, African, and East Asian countries. They do not qualify for government healthcare subsidies. Further, many of those who would be eligible for Medicaid extension by the ACA, which Virginia did not adopt, or other federal programs do not have any access or receive far less comprehensive care than they would at CrossOver. The tangled pool of partial-coverage plans from the government and other private entities leaves patients confused and disheartened. Despite the profound wealth and expenditures on healthcare in the United States, millions are uninsured and unable to receive the care they deserve.
Fortunately, the motivation and commitment of current and prospective providers serves as a source of hope for the future of healthcare. The improved, coordinated functioning of both federal and private sectors of insurance is possible, but the task ahead requires public resources to support the dedicated and passionate care that I have witnessed at CrossOver for the few that it is able to serve. The staff and volunteer nurses and physicians at CrossOver demonstrate motivation, compassion, and engagement to the delivery of care to all those who need it. However, free clinics can never ensure the healthcare all of our citizens deserve without public action. We must ascertain that all of our residents, not just citizens, are insured for quality healthcare like that provided by CrossOver. Despite the range of services offered by agencies like Planned Parenthood and Virginia Coordinated Care, such programs often treat certain conditions and not others. A fully comprehensive and sustainable healthcare program for all those residing in the United States must be implemented and offered.
In the meantime, the caring, selfless attitudes of providers receiving incomes far lower than they’d be paid elsewhere give me hope and inspires me to pursue a career in medicine in low-income communities. The most defining moments of my internship occurred during normal conversations in financial screenings with patients. Screenings were a special opportunity for me; talking with new patients about their lives and what brought them to CrossOver truly taught me how to listen in a new way. Even on the busiest, most stressful days in the clinic, patients thanked staff and volunteers, often expressing how important CrossOver was for them. Despite political and financial agendas that interfere with the universal right of healthcare, the raw emotional and human component of medicine drives many to fight for equal opportunity in healthcare. I’m eager to continue my journey to practice medicine and serve those who have already greatly broadened my horizons, shared their stories with me, and ignited a new passion within me for the delivery of compassionate healthcare to the poor. I am looking forward to advocating for the universal right to quality healthcare as well as providing this care to all residents as I experienced it at CrossOver Ministry.