November 6, 2003

When semi-retired heart surgeon Sam Selinger signed up for a week-long series of "refresher" courses at the Kennedy School of Government at Harvard University a couple years back, he had no idea that what he'd learn would change his life — and many other peoples' lives — forever. Yet it wasn't anything Selinger picked up in the courses he attended. Instead, it came in the form of an unexpected conversation with an old friend who told Selinger about a collaborative program that offers healthcare and prescription medications to people who do not qualify for health insurance. About seven years ago in Asheville, N.C., Dr. Susan Landis founded the program, called Project Access. Selinger says his friend had adjusted Project Access to work in Wichita, Kans.

"The more he was telling me about [Project Access] and how he translated it to work in Wichita," Selinger recalls, "the more I was thinking, 'If you can do this in these different places, why can't you do this in Spokane?'"

In September, after almost two years of planning and organizing, Project Access began helping people in Spokane. The program isn't a free clinic or an organization that offers funds for people without insurance. Rather, Project Access is a coordinated charity care system, set up among area specialists, clinics, hospitals and pharmacists, offering a full continuum of medical care for those who are not eligible for other forms of health insurance. There are currently about 20 Project Access programs throughout the United States.

According to the Spokane Regional Health District, about three-quarters of the people who have no health insurance are in families where at least one person is working. Project Access gives such people and others the opportunity to receive medical care if they are in transitional periods, such as waiting for their health benefits to kick in at a new job or if they just had a change in location or marital status. Project Access recipients must requalify every three months, making the program a temporary fix. Selinger suggests that's really what many people need.

"We can get people care so it keeps it from being a bigger problem," he says. "I saw someone who had to leave work because of a cough. She was six weeks away from getting health insurance through her work, and she was told if she [took more time off] she'd lose her job. She ended up having to go to the ER. She now has a huge emergency room bill, lost her job and is on welfare. She's 35 years old."

Selinger explains that Project Access would have covered the woman's visit to a specialist and any medications she may have required. Instead, she didn't get care, missed several days of work and ended up visiting an emergency room. Patients often go to the ER even for relatively minor concerns like having the flu, simply because they don't have any other way to receive care. Overloading the ER puts a strain on hospital resources.

"She could have kept her job, gotten on [the employer's] health plan, and been paying taxes instead of having a huge hospital bill and being on welfare. This was just a working person that one bad thing happened to."

Spokane County's healthcare community was eager to participate in Project Access, and Selinger recruited more than 500 area doctors (out of 950 in the entire county) to agree to see around 15 extra patients a year for free. All six hospitals in Spokane County agreed to treat Project Access participants at no cost, and pharmaceuticals are provided at wholesale cost by a number of private and public companies, which waive the dispensing fee and allow the use of their billing network for free.

Project Access received nearly $1 million from the Robert Wood Johnson Foundation. The city of Spokane gave $100,000 for pharmaceuticals; Spokane County gave a $25,000 Community Block Grant. The cities of Liberty Lake, Cheney and Airway Heights have budgeted money for Project Access in 2004.

"Mayor Powers has been incredibly supportive of this," says Selinger. "He's budgeted $150,000 for '04. From the beginning, he's seen how important this is." Selinger knows Project Access isn't designed to be a permanent solution for the healthcare crisis or for people who need long-term charity coverage; it simply eases the overall burden.

"This is what our community wants to do for ourselves," says Selinger. "It's about putting in a little extra. We have businesses, unions and churches contributing."

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