No insurance No access to care Yes, there’s help
A free clinic in Phoenix aims to plug a few of the gaping holes in the health safety net
She had canceled one appointment, then another, and now Jason Odhner was starting to worry about Maria. Her world, she said, had grown darker. Her phone was disconnected. She stopped taking care of herself, so Jason filled the prescriptions she couldn’t afford, packed a medical bag and prepared to bring the clinic to her.
“I was just checking to see if she needs any more pills,” he asked Maria’s daughter over the phone. “Does she have everything she needs?” His patients never had everything they needed. At the clinic’s front desk, he scrolled through medical files to find Maria’s. Each file flashed similar sets of complaints and chronic illnesses. Mercedes had a prescription that made her sicker than the disease. Yessica’s blood sugar was too high, and she ignored it. Patrick still hadn’t recovered from a stroke. Maria had a jumble of pills she couldn’t keep organized and diabetes that stole her sight.
But health care had become a product to be purchased, and patients at Phoenix Allies for Community Health were shut out of the market. “Medically marginalized,” Jason called them.
Almost all of the clinic’s 400 patients were immigrants. Most lacked legal status. None could afford health insurance, prescriptions or a trip to the doctor. Nobody else seemed to care.
“These are people who could live a normal life,” Jason said, and so he spent whatever time he could at the clinic, inside an old office building surrounded by a barbed-wire fence.
He and the clinic’s cofounders built a makeshift pharmacy in the back, filled tiny exam rooms with donated equipment and transformed a kitchen into the main office. They crammed desks in every corner and covered the bright-orange walls with posters and mission statements: Stop separation of our families. Together we can.
Jason, 40, arrived before breakfast for a day full of house calls. It had been two days since President Donald Trump had taken office, capping a campaign that promised to deport millions of people and roll back the government’s involvement in health care.
PACH felt its patients retreat. There were more missed appointments, fewer answered phone calls and more patients checking in with anxiety attacks.
“I’ve been worried about her for a while now,” Jason said, packing Maria’s charts into his medical bag. He dialed her number one more time, to be sure.
The line screeched back at him. Dead.
No access to care
A decade of healthcare reform had filtered more people than ever into hospitals and doctor’s offices, but preventive care stayed out of reach for most of the 11 million people in the country without legal status.
Government programs like Medicaid and Medicare required patients to be “lawfully present.” The Affordable Care Act blocked those without legal status from discounted insurance plans. Anybody could buy health insurance from private companies, but as the ACA pulled low-income Americans into its system, the price of private plans spiked. Hospitals were required only to provide emergency care and then could send people home.
The health of 11 million people was left to a patchwork of charity and community clinics. It was a safety net full of holes: The UCLA Center for Health Policy Research found that undocumented immigrants are significantly less likely than legal immigrants to see a doctor, visit the emergency room or report themselves in good health. Just 21 percent of them said they were in “very good” or “excellent” health.
As a nurse at a Phoenix hospital, Jason was forced to discharge patients after ensuring they wouldn’t immediately die. Their symptoms faded and returned, cycling them back through the ER, never treating their long-term health.
That was before PACH, when all Jason could do was never enough. He believed in treating the whole person, in reminding people they were important, in hope and love and the wondrous power of healing. He saw medicine twist the humanity out of people. Nurses scribbled charts and notes. Doctors wrote prescriptions. Surgeons clipped out malfunctioning parts. Who handled the rest? Why did his hospital colleagues stare back blankly when he talked of hope and healing?
These seemed to be unanswerable questions, so Jason made house calls with a doctor from his hospital. He loaded medical supplies in the back of the doctor’s Buick Skylark, and they visited a few patients on their days off.
Then in 2010, protests filled the streets. Jason brought together a loose collection of street medics.
They pulled on bloodred shirts and trailed the crowds, brought water to heat-stricken marchers and washed out eyes filled with pepper spray.
That year, Bob and Amy McMullen started to slip into the crowds.
Amy had never protested before Gov. Jan Brewer signed Senate Bill 1070, which required immigrants to carry their residency paperwork at all times. The activist community erupted. Notice of a rally against SB 1070 appeared on Amy’s Facebook page. “I’m attending,” she clicked, and within an hour, she had become an activist. The protests grew larger. The McMullens kept showing up.
They showed up again when neo-Nazis marched toward the Capitol. In November, the National Socialist Movement received a permit to rally in support of SB 1070, and activists planned a counterprotest. The two