Health Care for All, With Obama Down the Street

By:  Dan Barry
The New York Times


First through the door of the Portland Community Health Center on Thursday morning was a stick figure of a man, oblivious to the homemade signs and the White House advance team across the street. He had a bald eagle drawn on his sweatshirt, a street-hard weariness in his eyes, and a throbbing pain in his right hand.

Sarah Andel, a nurse practitioner, knew this man, James Hierl: how he lived in a shelter; how his depression made eating seem futile. As she held his numbed hand, working to remove a painful wart with a blade, she coaxed and coddled him: You have to eat; you have to see your psychiatrist; and please, James, eat.

“You’re going to come back in a week,” Ms. Andel said, as her patient headed for the door, finger bandaged, cheeks concave, looking older than his 53 years. “O.K., James?”

Mr. Hierl gave a hesitant nod. Soon he was out on Park Avenue, where a line was forming outside a brick bandbox called the Portland Expo. The reason: President Obama was to speak there in the afternoon about new health care legislation that, among other things, will provide a huge increase in money — $11 billion — to community health centers like this one.

Across the country, more than 1,200 of these centers are providing treatment to low-income patients who would otherwise linger in expensive emergency rooms. The law is intended to reduce the burden on Medicaid and help the centers serve 20 million more people.

So the day progressed. On one side of the street, Obama aides scurried, the police blocked off traffic, and people waited in the sun, holding signs that said “Thank You” — though by lunchtime, hundreds were chanting the opposite. And on the other side, uninsured and underinsured people sought care, beginning with a man who saw little reason to eat.

A year ago, there was no Portland Community Health Center, though for years the city had been seeking federal money for a center that would provide care regardless of income or insurance. One that would reach the many new immigrants and refugees — from Rwanda, Iraq, Congo — who are finding their way to this southern Maine hub; save money; offer help.

Then, last year, the city received $1.3 million in stimulus money to open a community health center. It created a board, hired a staff, and found some vacant but tired space in a building on Park Avenue. On Nov. 2, the doors opened.

Now clients walk into a waiting room where the walls have been painted a lively yellow. Some magazines, from The New Yorker to Diabetes Forecast, sit on furniture bought at Wal-Mart and Staples. Children have a play area in the corner. “We want it to be a place where people really want to come,” said Carol Schreck, the executive director.

More important than aesthetics is the staff. It includes three nurse practitioners, a registered nurse, a social worker, two medical assistants, and a pediatrician and a doctor who come once a week. An eligibility specialist is also on hand to help clients navigate a health care universe nearly confusing enough to require hospitalization.

Patients without insurance pay on a sliding fee scale that is made possible by Medicaid reimbursement. For example, if they earn $10,830 or less a year, which is the usual case here, they pay $3 a visit.

So far, this community health center has seen 750 patients who, employees say, would otherwise have gone to the emergency room or gone without treatment. Half have no insurance. Many are Mainers, but just as many are recently arrived immigrants who often bear the mental scars of war. Interpreters are part of the everyday life here.

Ms. Schreck said the new legislation means many good things for this center — including, perhaps, a dental clinic in the unused space at the back of the office. “We hope,” she said.

Through the morning and into the early afternoon, the health center provided a close-up view of the Obama line that snaked past the Portland Ice Arena, past an abandoned gas station, past a school for the visually impaired. People here said lines this long are seen only when the Maine Sea Dogs, the baseball team that plays in a nearby park, are giving out bobble-head dolls.

But Ms. Andel, 31, one of the three nurse practitioners, had little time to gawk. After the man who would not eat came another man, fresh to Portland from an Indian reservation several hours away, who was struggling with the anxieties of heroin withdrawal. After him, two women with back pain, then a man from Burundi who needed to undergo a physical as part of his path to earn citizenship.

Meanwhile, outside and just down the street, the last gasps of the yearlong argument about health care legislation found breath in chants of “Nobama!” and “Yes We Can!”

Here were people complaining that they didn’t like health care rammed down their throats (the preferred terminology for opponents). Here, too, was Kathleen Stokes, the president of the community health center’s board. She was standing in line with her ticket, telling anyone who would listen of the benefits of community health centers.

At 3:15 or so, a staff member at the front desk adjusted her computer to a live broadcast of the goings-on in the Portland Expo, just a few dozen yards away. A couple of minutes later, the strains of “Hail to the Chief” rang through the waiting area, as a smiling President Obama appeared on the small screen.

On Wednesday, there was a free tax clinic in the Portland Expo; on Friday, the Maine Red Claws basketball team will play the Fort Wayne Mad Ants. But right now the Portland stage belonged to a victorious president who began his speech with “Hello, Portland!”

Ms. Andel did not have time to watch the speech. At the same time that the president was talking, she was handling another tough case: a crusty woman of 60 who positively, absolutely, refused to take medication for her diabetes.

But after a lot of back and forth, the patient grudgingly gave in to the coaxing, coddling nurse practitioner. She agreed to make some dietary changes — and to come back to the community health center in a month.