Health-care gap grows between haves, have-nots, but there’s help

By on May 2, 2019

Chris Brethauer, with son Kieren, relies on the Community Care Clinic to treat his diabetes. (Victoria Bragunier)

Here and across the country, access to medical care and its costs are a topic of growing concern. The Centers for Medicare and Medicaid Services found that in 2017, health care spending grew by 3.9%, reaching $3.5 trillion or $10,739 per person.

Premium increases, higher deductibles and soaring prescription costs all factor into escalating prices, resulting in economic stress on consumers and a growing population of underinsured and uninsured people.

Employer-based coverage is getting more expensive, and for those buying insurance via the Affordable Care Act’s health exchanges or through private market plans, the average increase was $201 in 2018.

Though the monthly premiums for these types of plans may be affordable, the costs of accessing care remain prohibitive, causing a large number of patients to forego treatment.

N.C. lags behind in Medicaid coverage
Though the 2010 enactment of the Affordable Care Act was to serve as a new path for those who lacked coverage, it has left many behind. This is due to a substantial coverage gap for those who do not qualify for subsidies to help with buying insurance through the act.

To help them, the ACA allows for states to significantly expand eligibility for Medicaid. Under the law, those with incomes up to 138% of the federal poverty level would qualify for coverage in any state that participates in the Medicaid program.

Medicaid provides medical insurance to eligible low-income adults, children, pregnant women, the elderly and people with disabilities. It is administered by states, according to federal requirements, and is jointly funded by states and the federal government.

Participation in the expansion of Medicaid is not required, and while Gov. Roy Cooper has worked to broaden the program, that effort has been blocked by state legislators.

Reluctance to embrace Medicaid is not new for North Carolina, as it was one of the last states to adopt the program when it was originally introduced. Other states began providing Medicaid coverage in 1966, North Carolina did not do so until 1970.

The result of is that many of these individuals incur medical debt that damages their credit and hurts their long-term finances.

North Carolina has one of the largest uninsured populations in the country, with 1 million people living without health insurance, per census data.

Many of them work but do not receive health insurance through their employers. They tend to be small-business employees, and working part-time, temporary or seasonal positions.

In Dare County, 14.9% of adults 18 to 64 years old are uninsured, as reported by the North Carolina Institute of Medicine, a quasi-governmental agency.

Healthy citizens result in thriving communities. To help make that happen, the North Carolina Office of Rural Health started the Rural Health Program in 1973 to shore up the state’s health care safety net.

Though not a direct provider of care, it functions to assist underserved communities in accessing medical treatment by supporting health care organizations throughout North Carolina.

One such organization is the Community Care Clinic of Dare. The clinic, birthed from the Healthy Carolinians of the Outer Banks task force, opened its doors in 2005.

Clinic staff and operations are funded by grants and donations, and its functions are largely sustained by volunteers. Much of the funding has come from the ORH coupled with support from The Outer Banks Hospital, Albemarle Hospital, local government and private backing.

However, funding has proved a challenge recently, as the clinic lost its largest grant from the ORH, which provided $150,000.

Tami Montiel, executive director, outside the clinic.

“There have been state budget cuts, and a lot of competition for grants,” said Tami Montiel, executive director for the clinic. “There were 45 applications for 16 spots.”

Montiel said the clinic is financially sound, and will be reapplying for the funding in the upcoming grant cycle.

The clinic provides basic health care, medication assistance and a gateway to other ancillary medical programs for uninsured adults living and working in Dare County.

Those ancillary programs include NC MedAssist and Albemarle Project Access.

NC MedAssist is a nonprofit pharmacy program the provides prescription medication for the vulnerable and uninsured. To date, 21% of the prescription medications provided are secured from patient assistance programs available through pharmaceutical companies and 79% are purchased generics.

Albemarle Project Access delivers dental care for indigent and uninsured residents of Camden, Chowan, Currituck, Dare, Gates, Pasquotank, and Perquimans counties.

The clinic has two locations, one in Nags Head and the other Frisco. Spanish interpreters are available on select days.

To be eligible for services, patients must be between the ages of 18-64, can prove that they live or work in Dare County, have less than $10,000 on hand, and have a household income of less than 300% of the federal poverty level.

“We recently raised the limit of the level of income to 300% of the poverty level because so many people are unable to afford medical care,” said Montiel.

Under the raised limit, an individual making $37,000 a year could receive free health care at the clinic.

To better serve the community’s health needs, reaching out to the public has become a primary focus for Montiel. She explained that an important aspect of her job is to speak with local business owners and detail how the clinic can assist their employees who are uninsured.

When asked what types of treatment are most needed Montiel replied, “many of our patients have chronic diseases such as diabetes, thyroid and heart disease. These patients need access to labs and assistance with acquiring necessary prescriptions.”

One of those patients is Chris Brethauer. Brethauer, who works on a charter fishing boat, is a 49-year-old single father, and has been a patient at the clinic for the past seven years.

“My employer doesn’t offer health insurance and it cost too much to buy insurance on my own,’’ said Brethauer.

Diagnosed with diabetes at 25, proper medical management and prescription maintenance is imperative in treating his chronic condition. Brethauer said that his prescriptions would cost him $4,000 a month without the clinic’s help.

“I couldn’t do it without the Community Care Clinic,” he said. “I’m healthy and happy with their help. I’m able to raise my amazing son.”

To learn more about the Community Care Clinic, go to

See what people are saying:

  • Thinking About the Future

    The state of our nation’s “healthcare” is reprehensible. Every citizen deserves the same quality and level of healthcare services that their elected officials receive.

    Thursday, May 2 @ 8:12 am