A MARTÍNEZ, HOST:
This election year, National Public Radio will share stories that center on issues that matter to voters. One of those issues is health care. In a recent survey, KFF, which researches industry policy, found nearly three-quarters of adults in the U.S. are worried about cost. That's one of the barriers to accessing quality care. I heard about that myself on a recent visit to a clinic in Reno, Nev., that sees patients from underserved communities.
(SOUNDBITE OF BABY VOCALIZING)
UNIDENTIFIED PERSON: Oh, we're out of here.
MARTÍNEZ: In the lobby of this Community Health Alliance clinic, patients young and old wait for their appointments. And there we met the CEO, Oscar Delgado, who showed us around.
OSCAR DELGADO: So here we have a pharmacy, which is amazing for many of our patients. It's accessible. One of the things we also do, where we learned from COVID, is we do free delivery services for our patients, if they it's hard for them to come and get their prescriptions.
MARTÍNEZ: We were just in the lobby, and we made a right turn to go into the pharmacy. So they're, I mean, literally attached.
DELGADO: They're literally attached. And that's how they work.
Como estamos? How are you guys?
These were offices. We converted them into exam rooms. With the higher demand that we got going now, it's something we want to make sure we're always sensitive to. You can hear those noise machines. That's the behavioral health. You block out any outside noise of their confidential conversations that they're having with our LCSWs or MFTs.
MARTÍNEZ: He's talking about the licensed clinical social workers and marriage and family therapists that work here. And there's a lot more. There's also a pediatric area, a dental practice. CHA offers a lot under one roof in an underserved area. And those are some of the requirements to become a federally qualified health center, or FQHC. And they recently added something new.
EMMA MARTIN: I found out today that there is a food pantry that's offered here, which I think is awesome.
MARTÍNEZ: That is Emma Martin, a new patient at CHA, who first found the place a couple of months ago. She's 24 years old, a lifelong resident of Reno and has been diabetic for a decade. For her, having all of these services here is a blessing.
MARTIN: I don't own a car myself, so I have to take a Lyft everywhere. And honestly, it helps my budget, and it helps also to have everybody know what I need in one place without having to repeat myself, what I'm going through in my health process.
MARTÍNEZ: Emma has worked in retail, but she's currently unemployed. CHA helped her get health insurance, a process that she found so confusing when she was trying to do it on her own that she almost quit caring for her health.
MARTIN: I was about to give up, honestly. So when I first found out I was diabetic, I was 14 years old. Did not take medication for about 10 years. And when I was an adult, I tried to look for proper doctors to help me on medication. And I was having so much issues with taking my medication, how much I should be taking, how many doctors appointment I should go to, to the point where I just didn't want to do it anymore.
MARTÍNEZ: Emma is an example of the kinds of patients an FQHC serves. The passage of the Affordable Care Act in 2010 increased their funding to help meet the needs of people who are able to get insurance as a result. But in Nevada, getting to see a doctor is still really tough. It has among the lowest number of primary care physicians per capita in the country. In the conference room at CHA, I asked their chief medical officer, Dr. Travis Walker, about that.
Do people, if they can't see a doctor or get services, do they give up?
DELGADO: Yeah, absolutely. I mean, and they will push off caring for themselves. They will develop a tolerance for these things that they shouldn't, like, you know, you never went and got routine care and you never found out you had high blood pressure. And soon enough, you're having a heart attack. I mean, there's tons of examples in my career, which has entirely been in this state, that I've seen people forgo care because they didn't see that they had the ability to go see a doc. It's a tragedy.
MARTÍNEZ: This is part of the reason Nevada is one of the unhealthiest states in the nation, down in 42nd place, according to an annual report from the United Health Foundation. And at CHA, recruiting doctors and keeping them there is difficult if federal funding is not there to support the clinic.
TRAVIS WALKER: We see a sizable portion of people who truly don't have an ability to pay. And so really, the biggest thing is finding people who are driven by passion and less by reimbursement. It's tough when you're competing with a hospital system or a private practice who limits the number of patients who can't pay or eliminates patients who can't pay because they can make more. And it's tough when you can say, hey, these guys are paying us X, but these guys are paying us, you know, 10, 30, 50 more a year as a provider.
MARTÍNEZ: All this brings us to the politics of health care and this year's presidential election, which is likely to be a rematch between Joe Biden and Donald Trump.
LARRY LEVITT: They could not be further apart when it comes to health care policies.
MARTÍNEZ: Larry Levitt is the executive vice president for health policy at KFF.
LEVITT: And those policies absolutely trickle down to states and to communities.
MARTÍNEZ: Levitt says November's election will be unusual in that we're likely to have two candidates whose records on health care while in office we can directly compare.
LEVITT: President Biden made a centerpiece of his campaign in 2020 to reinvigorate the Affordable Care Act, or Obamacare, and he has done that. We have record enrollment. We have the lowest share of the population uninsured in history. That makes a difference.
MARTÍNEZ: And it stands in contrast to the Republican front-runner.
LEVITT: Former President Trump, when he was in office, tried unsuccessfully to repeal the Affordable Care Act and cap funding for Medicaid, the health care program that serves low-income people. And he's recently been vowing once again to try that if elected.
MARTÍNEZ: Levitt believes that means voters have a clear choice between the candidates when it comes to health care. Talking to Dr. Walker at CHA, he's careful not to comment on politics but admits that when he goes to vote this November, it's going to be difficult not to be influenced by the clinic's mission.
WALKER: That's probably going to be the predominant thought. I mean, we get so much funding that we work toward for the federal government, and if I knew that there was somebody on the ballot that couldn't support this with as important as it's kind of become to me and to the community, that person wouldn't get my vote.
MARTÍNEZ: For CHA patient Emma Martin, voting is something she hopes people will take seriously.
MARTIN: I feel like it's more of a conversation that people need to have openly because it does affect people here in Nevada. Absolutely. And it affects important things that happens in daily lives.
MARTÍNEZ: And that is the power voters have to decide elections, which could impact the future of health care for millions of Americans.
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