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She was fighting exhaustion.
Carmen had hypothyroidism, a condition that caused her hair loss and muscle pain. If untreated, the thyroid disorder can lead to other health problems. But Carmen hadn’t been able to see a doctor for about a year because she didn’t have any medical coverage.
“I felt extreme fatigue,” said Carmen, 57, who asked that only her first name be used for privacy reasons. “It’s almost as if I couldn’t get out of bed. I was depressed.”
The Downers Grove woman discovered a program that helps uninsured people in DuPage County gain access to low-cost health care. Patients enrolled in Access DuPage pay no more than $15 for a primary doctor visit. Carmen currently pays $4 for medication to manage her thyroid issue.
“Now, I have no pain,” she said through a translator. “The chronic fatigue is no longer there. My life is much more normal now, as normal as it could be with a diagnosis like this.”
Before the Affordable Care Act passed in 2010, some 12,000 to 15,000 people signed up for Access DuPage each year. Illinois has, in recent years, expanded a Medicaid-like program to cover more adults, regardless of immigration status. But coverage gaps remain: Access DuPage served 5,741 people in fiscal 2022, almost 8% more than the previous year. Most are low-income workers.
In the economic fallout of the pandemic, “there’s just an awful lot of families that still don’t have enough resources to make ends meet,” said Kara Murphy, president of the DuPage Health Coalition, the nonprofit that operates Access DuPage.
“And so even though there are some new pathways to insurance coverage,” she said, “there are more people coming into the pipeline that also need help through programs like ours.”
The DuPage Health Coalition is among five recipients of a grant from the Neighbors in Need campaign, a Daily Herald and McCormick Foundation partnership that helps fund agencies addressing hunger, homelessness and health inequity in the suburbs.
Physicians affiliated with every hospital in the county volunteer their time and expertise to care for Access DuPage patients. Dr. Kevin Most, chief medical officer of Northwestern Medicine Central DuPage Hospital, chairs the coalition’s board.
“Look at the diabetic we keep not only out of the emergency room, but we keep them out of the intensive care unit. Look at the hypertensive patient who we keep out of dialysis by getting their blood pressure down,” Most said. “We stop them from having a stroke and ending up with a disability. We stop them from having a heart attack.
“We’re extending their lives so that they can watch their grandchildren grow up,” he said. “They can watch their children get married.”
How the model works
Access DuPage started more than 20 years ago as a collaboration of social service agencies, county government, hospitals and physician groups.
Putting aside competitive issues, hospital leaders signed on to provide health services. Collectively, hospitals donated the first $1 million needed to launch the program in 2001.
“The health of the community goes beyond those who can afford insurance, and I think that was the whole foundation for it,” said Most, a board member since its inception. “We have this group, this population that falls between the cracks. They don’t qualify for Medicaid. Their workplace may not provide insurance, and yet they’re still needing medical care.”
The volunteer network now includes hundreds of primary care physicians, Murphy said. The coalition handled more than 1,600 referrals to specialists in the past year. More than 28,000 prescriptions were filled as part of the program.
The nonprofit covers about $325 in direct costs per patient. Through pro bono medical services and financial assistance, hospitals and health care systems contributed more than $38 million in support in 2022.
“All of the hospitals are very financially supportive of us, and the reason is that we’ve proven to them that we will have these patients in your emergency rooms less,” Most said.
The alternative: People who lack health insurance often go without treatment until they land in the hospital with a crisis that could have been avoided with primary and preventive care.
“If a hospital has 20% of the people walking in its door that don’t have the means to cover the cost of their care … that results in a number of things,” Murphy said. “Higher costs at the health system level, but also higher insurance premiums.”
‘A big difference’
To qualify, uninsured adults must live in DuPage and have annual incomes up to 250% of the federal poverty level. For a household of four, that’s $69,375.
Patients live in every ZIP code in DuPage. The coalition sees the highest enrollment numbers in West Chicago, Addison, Bensenville and Glendale Heights, communities with large Latino populations that were hardest hit early on in the pandemic.
About 93% of patient households have at least one working adult. “A lot of our members work in pretty physically punishing jobs,” Murphy said, citing patients with orthopedic problems.
If a recession hits and unemployment creeps up, the coalition expects to see increased demand next year. Enrollment in Access DuPage skyrocketed during the last financial crisis, Murphy said.
The unknown is if state lawmakers will continue to extend Medicaid-like benefits, especially for younger immigrants who are not eligible for Medicare or Medicaid.
“Then that may help to balance out some of the new need that comes to us,” Murphy said.
She stresses that Access DuPage is not a replacement for insurance.
“We would always want folks to be insured if they had a pathway to that, but in the absence of that pathway, it really offers a fairly comprehensive set of resources and access to really the very best providers that our community has.”
Patients are treated with dignity, Most said. They receive a card to show at the doctor’s office so they don’t have to fill out extra paperwork.
Carmen, the Downers Grove woman, remembers her first phone call to the coalition about three years ago. “Don’t worry,” staff members told her. “We’re going to figure this out.”
“I would go as far as to say that they personalize the treatment with us,” said Carmen, who’s now unable to work, while her husband does.
When she ended up in the hospital with severe symptoms of COVID-19, everything was covered by Access DuPage. It’s given her a “great sense of security.”
“It’s very hard when you don’t have access to anything,” she said. “And just knowing that someone is out there willing to help you, it makes a big difference.”