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The Fine Print of “Universal” Healthcare

By Cameron Lee, Washington and Lee University (2017)

“¿Puedo confiar en ti?” This expression, meaning “Can I trust you?” in Spanish, took me aback when a patient asked me during the first new patient screening that I conducted at CrossOver Ministry. While it was a question that I had subconsciously expected during my work at a clinic with a patient population consisting mostly of immigrants, this question had not been a concern of mine as a patient in the past. Confidentiality is something that many Americans take for granted in healthcare settings; however, despite privacy protection laws such as HIPAA, this remains, understandably, the utmost concern of numerous undocumented immigrants in the United States today. How is it possible, then, to make immigrants feel secure in a healthcare setting if they constantly feel burdened by the looming threat of deportation or incarceration? Doubtful of my ability to completely alleviate the patient of her insecurity in our clinic, I made eye contact with her and sincerely replied in Spanish, “Of course you can trust me, I am here for you.” Despite my uncertainty, I immediately noticed by the change in her facial expression that much of her previous anxiety had vanished.

"I made eye contact with her and sincerely replied in Spanish, “Of course you can trust me, I am here for you,” writes Cameron Lee (W&L 2017), who interned at CrossOver Ministry in Richmond (2015).

“I made eye contact with her and sincerely replied in Spanish, “Of course you can trust me, I am here for you,” writes Cameron Lee (W&L 2017), who interned at CrossOver Ministry in Richmond (2015).

This past summer, I had the incredible privilege of working as a Medical Administrator at CrossOver Healthcare Ministry in Richmond, VA. CrossOver, a network of free health clinics serving those who are uninsured and at or below 200% of the federal poverty level, provides a much-needed link between quality healthcare services and those that are often excluded from services such as Medicare or Medicaid. At my particular clinic, these individuals consisted mostly of immigrants who are barred from receiving adequate care due to their undocumented status. As an intern, I was primarily responsible for checking in patients for their appointments, scheduling appointments for patients, translating for Spanish-speaking (and, with my best attempt, Portuguese-speaking) patients, scribing for healthcare providers, and conducting new patient financial screenings. I really enjoyed the opportunities that these tasks presented to interact with patients and to grasp the nature of the daily operations occurring within a free clinic. Despite the fact that free clinics are typically limited with the resources at their disposal, CrossOver provides an exceptional level of care while continually seeking to expand its patient population and deliver care to those in need. In addition to having some physicians on staff, CrossOver utilizes volunteer primary care and specialty care physicians. Furthermore, if CrossOver lacks a specialty needed by a particular patient, it relies upon Access Now, a Richmond-area specialist referral network for those with low socioeconomic status. Regardless of the healthcare providers and services available to the clinic at a particular time, CrossOver’s staff and volunteers always meet and exceed the healthcare needs of their patients, as they see patients not as “immigrants” or “the poor” but for who they are—humans. This holistic approach to medicine, I believe, allows CrossOver to effectively remove the barrier between healthcare providers and under-resourced individuals in the Richmond area.

SHECP Intern Cameron Lee and other CrossOver Ministry Interns in 2015.

SHECP Intern Cameron Lee and other CrossOver Ministry Interns in 2015.

While CrossOver provides high quality healthcare to over 7,000 patients at a given time, there remain thousands of people without access to healthcare in the Richmond metro area. This may come as surprising to some with the recent passage of the Affordable Care Act (ACA). However, from what I have perceived, this legislation has expanded health insurance of Americans, but it has not increased the access to healthcare for everyone in America. For example, many states, including Virginia, opted out of Medicaid expansion, leading to less of an increase in healthcare access and coverage in these states. Additionally, many undocumented populations and incarcerated populations outside of Medicaid expansion states are barred from receiving Medicare or Medicaid due to enrollment restrictions. Unfortunately, universal coverage has not come with increased coverage and access. Furthermore, the uninsured patients that CrossOver serves generally have histories of frequent emergency room visits. These greater numbers of visits often lead to insurmountable hospital bills and a lower state of overall health for the impoverished individuals that form CrossOver’s patient population, as emergency room visits provide neither holistic nor high-quality care. The combination of these factors results not only in cyclical health issues for those in poverty but also an inherent difficulty in improving their socioeconomic status. Therefore, the Affordable Care Act is not a cure to bring all individuals to a better state of wellbeing in America—more must be done to make universal healthcare more inclusive. I do not intend to undermine the efforts that this legislation has achieved to reduce the suffering of impoverished Americans. Nevertheless, after my conversations with patients and staff at CrossOver, I have become more skeptical, not with the concept of universal healthcare itself but with the way that it has maintained healthcare’s exclusivity in America. Granted that other states may cover the very poor with Medicaid, no public insurance in any state covers undocumented and recent immigrants. Policymakers should concentrate on expanding healthcare access to those residing in the United States—finding a sustainable link between America’s advanced system of healthcare and all of its impoverished residents is essential to making healthcare truly universal. After my experience this past summer, I believe that the most viable route for bringing adequate healthcare to all residents, especially undocumented and recent immigrants, is to invest more heavily in community clinics and free clinics. These investments would expand healthcare access and improve the quality of healthcare for those currently not reached by the ACA. This plan of action may not be the sole solution for alleviating the lack of access to healthcare in America, yet it would be a step in the right direction to supplement partially expanded coverage under the ACA.

Although systemic changes to increase access to healthcare in America will not occur overnight, much can be done presently to contribute to the overall wellbeing of patients. Through my invaluable experience at CrossOver, I have taken away much from my own interactions and experiencing other staff’s interactions with patients. If I were to pinpoint the single most important lesson that I have taken away from this internship, especially when serving in a healthcare setting, it would be to possess the trait of a humanizing attitude. By humanizing, I do not intend to convey an attitude of superiority to patients. However, I believe that fostering an environment where individuals feel human allows them to escape their debilitating situation, whether it is one comprised of poverty, social isolation, or fear. Even on the most stressful days at the clinic, observing staff and volunteers employ this tactic and employing this tactic allowed me to recall my purpose at CrossOver: to provide compassionate healthcare and to connect community resources and talents with people in need. Furthermore, recognizing how serving with compassion can transform patients’ lives by simply acting as a fellow human for them to confide in, made my whole experience worthwhile. This sentiment ultimately reaffirmed my ambitions to pursue a career in medicine, yet it also sparked a desire within me to deliver healthcare to under-resourced communities. I am extremely appreciative of my experience as a Shepherd intern, and I look forward to doing my share to help expand access to healthcare with compassion—like I experienced it at CrossOver.


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