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Commission proposes a local solution to a community problem
"CHOICES" health care measure on Aug. 31 ballot
Cynthia Moore Chestnut
July/August 2004
John has always enjoyed hard work. "It's just in me," he says. "It's the way my father brought me up."
The 32-year-old former football player has battled diabetes for about four years. Not long ago, during a day off from his job at a local steak house, John was helping a neighbor in his apartment complex work on his car. Going back to his apartment for a tool, John stepped awkwardly off a curb and twisted his ankle-at least he thought he twisted it.
"I'm used to playing in pain," John said. "It hurt, but I figured I could just walk it off."
John wrapped his ankle and went to work the next day--in pain. It took two weeks, before he finally went to the emergency room. "They told me my ankle wasn't twisted, it was broken."
He did not have the insurance required for treatment, and his injury was not life threatening. So doctors put a soft cast on his ankle and sent him home. They told him to make an appointment with his family doctor.
John was embarrassed because he still owed money to his physician from previous treatment for his diabetes and he couldn't afford to pay the new bill. He decided to keep the soft cast on, rewrapping it occasionally and went back to work. All the time delaying the treatment he really needed.
Walking became more and more difficult for John and he began to express his pain in the form of anger toward his fellow co-workers. "It was the pain," John said. "I was starting to take an attitude and be mean. It just hurt so bad."
After his boss found it necessary to take John off the schedule at work, he went to the UF Shands Eastside Practice, which referred him to We Care. We Care is a network of volunteer health-care providers operated through the Alachua County Health Department.
Due to complications from John's diabetes, his fractured ankle had developed into a charcot joint - a condition in which the bones deteriorate.
The volunteer We Care physicians treated John for six month before realizing his best hope for treatment was the amputation of his lower leg. Though he is now in a wheelchair, John is now in Vocational Rehabilitation. He will be fitted for a prosthetic leg and he hopes to return to work.
"I'm going crazy in this chair," he said. "I need to get back to work."
There are close to 14,000 residents in Alachua County caught in a bind just as John, they cannot afford to see a doctor or nurse when they have warning symptoms like chest pain, dizziness, and shortness of breath, wounds that won't heal or dangerously high blood pressures. Oftentimes they put off seeking medical help until the illness becomes more acute and unintended consequences occur. A local solution to this problem is proposed - CHOICES.
After working with a group of citizens for over a year, we have developed a plan to address access for basic health care for Alachua County working residents.
CHOICES ( Community Health Offering Innovative Care and Educational Services) is developed to address the health care needs of the 14,000 uninsured workers in our community. These are residents who fall through the cracks because they make too much money to qualify for Medicaid yet they do not earn enough to afford health insurance or to pay out of pocket for health care. The working uninsured work everyday and yet they cannot afford one of the basic necessities of life-healthcare. Who are the working uninsured? They are our neighbors, farmers, OPS workers at the University of Florida, hairdressers, barbers, sub-contractors, restaurant workers and many more who provide a service to our community.
CHOICES will consist of two components:
Direct Healthcare for the Working Uninsured:
Disease Mangement and Health Education:
Focus on prevention and health education for chronic illnesses that lead to lower productivity and unnecessary emergency room visits and hospitalizations:
We would use existing health facilities such as the Alachua County Health Department satellite sites in Alachua and High Springs, the Archer and ACORN Clinics to provide basic care to the working uninsured. There will be a co-pay for these services. CHOICES is not an insurance plan.
How will be pay for the services? A 1/4 cent sales tax to fund CHOICES will be on the August 31 ballot. I believe a sales tax is a fairer approach to addressing this issue because everyone pays, even the people who will benefit from the service. The sales tax would generate an estimated $7 million a year with a sunset in 2011 when it would have to be voted on again by the taxpayers. 100 per cent of the sales tax will be used to fund health services and program costs without using property tax revenues. The average consumer may expect to pay an additional $15-20 a year in sales tax, a $1.25 per month to help a neighbor access health care.
Look for this issue on the primary election ballot August 31--when everyone will have the opportunity to vote their choice.
Cynthia Moore Chestnut is Vice-Chair of the Alachua County Commission
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