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Jim Kenyon: Good Neighbor Health Clinic a 25-Year Stop-Gap Measure

  • Valley News columnist Jim Kenyon in West Lebanon, N.H., on September 15, 2016. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Geoff Hansen

Published: 3/26/2017 12:32:13 AM
Modified: 3/27/2017 10:56:44 AM

When the Good Neighbor Health Clinic opened in Hartford 25 years ago, the doctors behind the free primary care clinic expected it was only a matter of time before they’d be out of business. And that would be a good thing.

The clinic’s demise would signal the U.S. had finally joined other developed nations in offering universal health care.

“We never really thought the clinic would last,” said Paul Manganiello, who, along with fellow Upper Valley physician Peter Mason, got the clinic off the ground in 1992. “We figured it was just a stop-gap measure.”

Meaningful health care reform, led by then-first lady Hillary Clinton, appeared on the verge of passing Congress in 1993.

But Republicans and some Democrats, as well, who argued health care for all would be too costly and complex, won out. By 1994, the Clinton administration had abandoned its “Health Security” proposal.

In the Upper Valley, Good Neighbor became an invaluable safety net for the working poor — adults who can’t afford insurance but earn just enough to disqualify them from government assistance.

In 1996, Good Neighbor expanded to include dental care. The Red Logan Dental Clinic, relying largely on volunteer dentists, hygienists and dental school students, handles everything from cleanings to dentures.

After the Affordable Care Act, passed in 2010, there was a “misperception that everyone got insurance,” said Good Neighbor board Chairman Jason Aldous, director of strategic planning at Dartmouth-Hitchcock.

While 20 million people nationally gained coverage under the ACA, the ranks of the underinsured swelled as premiums shot upward. Policies with deductibles of $5,000 to $10,000 became commonplace.

“People might have insurance, but if they can’t afford the deductibles, they are essentially without insurance” said Dana Michalovic, Good Neighbor’s executive director.

Between its two clinics, Good Neighbor provides more than $1 million annually in free care. Last year, nearly 1,300 people who live within a 30-mile radius of White River Junction accounted for 3,000 patient visits.

The clinic is open most weekdays and evenings by appointment. It also runs a weekly satellite clinic at the Claremont Soup Kitchen and makes regular house calls to the Upper Valley Haven, the homeless shelter in Hartford.

With a roster of two dozen physicians who volunteer three or four hours at a time, the clinic can usually see a new patient within a week of calling. “We need more nurses,” Michalovic added, not missing an opportunity to get in a recruiting pitch.

Patients seeking mental health treatment are also on the rise, creating a recently filled need for a second volunteer psychiatrist.

The nonprofit organization’s website includes an income chart to give people an idea of whether they might qualify for free care. For a household of four, the maximum gross income must fall under $5,052 a month (roughly $60,000 a year). But I haven’t heard of Good Neighbor turning away anyone who calls. Under Obamacare, the clinic has taken on more paperwork, helping people sign up for insurance and figuring out their eligibility for government subsidies.

Over the years, Dartmouth-Hitchcock Medical Center and Alice Peck Day Memorial Hospital in Lebanon have provided significant financial support.

Makes sense.

Good Neighbor’s preventive care and management of chronic illnesses, such as diabetes, hypertension and asthma, can reduce costly visits to the hospitals’ emergency departments.

Good Neighbor receives a sizable annual grant from the state of Vermont, too. This year, Hartford and Lebanon are each contributing $7,500 in taxpayer money.

Two-thirds of Good Neighbor’s patients are New Hampshire residents, but the state doesn’t kick in. (Why isn’t that surprising?)

Federal support is also lacking, although to be fair, Good Neighbor wouldn’t be the place it is without the efforets of the late U.S. Sen Jim Jeffords, of Vermont. In 2001, Jeffords secured a $750,000 federal grant that transformed the former Gates Memorial Library in downtown White River Junction into a modern medical office while preserving the historic building’s vaulted ceilings, hardwood floors and stained glass windows. The dental clinic occupies the renovated bottom floor.

With Donald Trump and the Republican-controlled Congress bent on dismantling the ACA, Good Neighbor could be needed more than ever. No matter what Republicans come up with, it seems almost certain that Medicaid will take a hit. A major component of the plan that was withdrawn Friday targeted Medicaid by rolling back its expansion and limiting federal payments to states.

Craig Westling, vice chairman of Good Neighbor’s governing board, works at the Dartmouth Institute for Health Policy and Clinical Practice. He points out that Good Neighbor has succeeded in evolving over the years to meet the Upper Valley’s changing needs. Taking on more of the underinsured after the ACA went into effect is a good example. “We don’t know exactly what’s next,” Westling said, “but it certainly looks like we’re going to have more demand for our services.”

Good Neighbor and Red Logan have a combined operating budget of about $650,000 a year. Nearly half — $300,000 — comes from private donations.

“We’re a pretty resource-rich area,” said Manganiello, who remains Good Neighbor’s volunteer medical director. “People have been super generous.”

No doubt Good Neighbor’s future well-being depends on that local generosity continuing. Washington certainly can’t be counted on, except perhaps to continue failing to do what’s necessary to put Good Neighbor out of business.

Some things don’t change in 25 years.

Jim Kenyon can be reached at jkenyon@vnews.com.




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