The charts below (Figures 8, 9, 10, & 11) show healthcare data based on the most recent 2017 data from the Census Bureau which was released in December 2016 and tracks healthcare in the United States.

The first two charts show the percentage of people who do not have health care insurance, with data broken out by household income level. Figure 8 shows the percent with no insurance coverage by income group. In Union County the highest percentage of people not covered with insurance (24%) are those earning less than $25k.

Figure 9 shows the change in the percentage of people who have no insurance from 2015 to 2016. Union County’s highest change in the percentage of people not covered with insurance of -1.0% for under $25k-change.

Figure 10 shows a breakdown of the people in the area who do not have health insurance. Of the people who DO NOT HAVE healthcare coverage, what is the breakdown by race. Union County has the percentage of whites without coverage the second smallest when ranked by whites without coverage of all the other counties in the surrounding region at 10% of the total. Second, it has one of the largest proportions of black or african americans without coverage at 26% of the total and is ranked #2. The only larger county being Mecklenburg County with 34%. The next chart shows the percentage of children (17 years of age and younger) who do not have health insurance. 

The next chart (Figure 11) shows the percentage of children (17 years of age and younger) who do not have health insurance.  Union County has 5.3% of its children without health insurance, which is the 3rd most of all other counties in the area.

Access to affordable, quality health care is important to physical, social, and mental health. It is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all Americans.  Health insurance helps individuals and families access needed primary care, specialists, and emergency care, but does not ensure access on its own—it is also necessary for providers to offer affordable care, be available to treat patients, and be in relatively close proximity to patients.  Additionally, availability of transportation is a key component of ensuring access to care.

The recent COVID pandemic results in extra challenges with these measures - as there is an increased need for health services but, loss of jobs may mean loss of health insurance. Some areas of the County experience access barriers significantly more than other parts of the county – great disparity. Clearly a concern to the community and leaders, which is why it has risen to the attention of this group.

Positive Factors

Affordable Care Act

The Affordable Care Act, also known as "Obamacare", was developed to help individuals' access affordable health insurance through a health insurance marketplace where Americans can purchase federally regulated and subsidized health insurance during open enrollment. The implementation of the Affordable Care Act (ACA) in 2010 meant thousands of previously uninsured North Carolinians could obtain health insurance. In 2012, 16 .6 percent of North Carolina residents did not have health insurance; in 2016, that percentage decreased to 10.4 percent.

Telehealth/Teletherapy Options Available

As per the CDC, changes in the way that health care is delivered during this pandemic were needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Telehealth – the use of communication and information technologies to access health care services remotely– has provided a great benefit to many patients. Not only does telehealth bring healthcare services to you at any moment, but also it addresses the scarcity of providers in remote areas, the lack of proximity to health care facilities, the restricting schedule, and the unreasonable cost. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care. Many physicians and mental health professionals in Union County utilize telehealth or teletherapy. 

Free and Reduced Fee Clinics in Union County

There are a number of free or reduced fee clinics who provide services to the uninsured in Union County. Community Health Services of Union County, Inc. provides basic primary healthcare, Annual Wellness exams, Sick Visits, and Chronic Disease Management for our Union County, NC  uninsured residents. 

HealthQuest is a licensed non-profit pharmacy that provides free medication to residents of Union County to treat their chronic medical conditions. HealthQuest assists people without prescription insurance or other reimbursement and who are without funds to buy maintenance medications.  HealthQuest provides medications for conditions such as high blood pressure, depression, high cholesterol, diabetes and many others.

Since 1937, Union County Public Health has been helping prevent and reduce the spread of disease through education, nutrition intervention, and consultation, and by providing immunizations, sanitation and enforcement of state and local laws. Health Services is here to serve Union County residents in the prevention of disease, promotion of health and the protection of our community’s health. Union County Division of Public Health accepts cash, credit card, debit card, most major medical insurances and Medicaid. Patients without insurance will be asked to provide proof of income to determine cost of services.

Mobile Medical Screenings and Events

Union County Human Services Agency collaborates with both Novant Health and Atrium Health to bring preventative screenings, such as mammograms, to underserved populations.  

Restricting/Negative Factors

Lack of Insurance 

Even though the number of insured people increased in NC and in Union County, there are still thousands more without health insurance. North Carolina’s uninsured rate is the ninth highest in the nation. Some individuals and families do not have sufficient income to qualify for an insurance subsidy, yet those same individuals do not qualify for Medicaid, resulting in a persistent gap in health care coverage. In NC, the lack of insurance disproportionately affects Hispanic/Latino and American Indian populations, impacting 29.6 percent and 18.2 percent of these populations respectively. There is a number of undocumented Hispanic/Latino residents in Union County (approximately 30,000).

An average of 89.5% of the Union County population has public or private health insurance coverage, yet the rates range across the County from 69% to 98% depending upon the geographical area of residence. In addition, there is a direct relationship between resident’s income level and whether they have insurance coverage - the higher the income level, the higher the rate of those insured. In households with the highest percentage of uninsured, 29% live below the poverty level, 18% have limited English proficiency, 45% live in single parent households, and 54% spend over 30% of income on rent.

According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents, 15.5% of teens, 24% of adults, and 20% of senior adults cited lack of insurance as a reason for not seeing a doctor during the last 12 months.

No Medicaid Expansion 

North Carolina is just one of 12 states that have not yet expanded Medicaid – which means federal dollars flow to other states, but not ours. We can bring more of our tax money home, expand access for working North Carolinians, and reduce state costs for treating the uninsured. About 634,000 people could benefit if North Carolina expanded the Medicaid program to cover more people, according to a report from the Cone Foundation in June 2019 on the effects of the policy. The report, commissioned by two state foundations and completed by economists from George Washington University, says that Medicaid expansion would inject about $11.7 billion in federal funding into the state between 2020 and 2022, produce about 37,200 jobs and boost North Carolina’s Gross State Product by $2.9 billion in 2022. Sixty percent of North Carolinians in the coverage gap are in working families. In fact, 100,000 full-time workers in our state live between 100 percent and 125 percent of the federal poverty level. Those without health insurance often wind up in the emergency room with preventable, and costly medical conditions. North Carolina hospitals would see a reduction of $3.4 billion in uncompensated care through closing the coverage gap, which would have a particular impact on our struggling rural hospitals. When hospitals provide care without reimbursement, costs rise for everyone, including those with insurance. Medicaid expansion, would make a significant dent in the state’s uninsured population, decreasing the rate of people without insurance by roughly 3 percent. 

High Costs

15 .5 percent of North Carolina adults could not see a doctor due to cost. Fewer whites experience this barrier to health care (12 .8 percent).  More than a quarter of the Hispanic/Latino population (27 .4 percent) indicate that cost prevented them from accessing a doctor in the previous year.

According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents, 14.6% of teens, 48% of adults, and 50% of senior adults cited lack of money as a reason for not visiting a doctor in the last 12 months. 

The Mental Health Parity and Addiction Equity law (MHPAE) was enacted a decade ago and promised the equal coverage of mental health and substance use services. However, the rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments. The rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments.

In NC, 11.9% of children have private insurance that did not cover mental or emotional issues. The proportion of youth in NC with private insurance that did not cover mental or emotional difficulties nearly doubled, from 4.6 percent in 2012 to 8.1 percent in 2017. In NC, 10.8% of adults with mental illness are not insured. (2017 National Survey on Drug Use and Health: Detailed Tables https://www.mhanational.org/mentalhealthfacts)

Language Proficiency

Along with a lack of insurance and lack of physicians in Union County, many Latinx Union County residents do not speak English or have limited proficiency with reading/writing.  This can be a barrier to accessing care in the community. 

Transportation

Transportation is a key component of ensuring “access to care.” 90.4% of Union County residents own a vehicle while 1.8% of the population has no means of transportation. While this percent is low, there are areas within the County where this is as high as 8%. In addition, there is no public transportation in Union County. The Human Service Agency's Transportation Division (UCT) is Union County's only source of public transit, and our transportation services are available to all County residents.  According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents: 18.5% of teens and 3.9% of adults cite lack of transporation as a reason to not see a doctor when needed. 

Program Awareness

Community members are often unaware of the resources which are available to them, multiple ways to disseminate this information needs to be developed. According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents, 19.4 % of teens cited that they did not know where to go for medical services.  

Anticipated Factors

If no changes are made to how services are delivered , the number of residents with insurance, or the ratio of healthcare professionals delivering health and mental health services, then we expect that the disparities in our community that exist will grow and there may be an increase in the underserved population. 

Behavioral Health Providers

• Cardinal Innovations
• Daymark
• Center for Emotional Health
• NAMI
• Thompson 
• Atrium Union
• Bridge to Recovery
• McLeod Addictive Disease Center

Healthcare Providers

• Primary Care Physicians and Specialists in Union County
• Community Care of North Carolina
• Community Health Clinic (free clinic)
• HealthQuest 
• Matthews Free Medical Clinic
• Atrium Union 
• Novant Health
• Union County Health Department Clinics
• Union County Human Services Dental Clinic

Non-Profit Organizations

• Common Heart
• Crisis Assistance
• Community Shelter of Union County
• Council on Aging
• Turning Point
• Heart for Monroe
• Operation ReachOut

Schools and Universities

• Wingate University
• South Piedmont Community College (SPCC)
• Union county Public Schools
• Union Academy (Charter School)

Union County Government 

• Human Services Agency -Department of Social Services, Health, Transportation, Veterans Services, Community Support and Outreach
• Union County Communications Department
• Union County Library
• Board Of County Commissioners
• Municipal County Leaders
• NC Cooperative Extension

Existing Coalitions and Community Committees

• Thrive!Union
• System of Care (SOC)
• Health Equity Committee
• Safe Kids

Business Community

• Chamber
• Rotary Club
• Transportation Agencies

Other

• Housing Authority
• Faith-based Organizations
• Activists/Community Volunteers

Steering Committee Recommendations

Utilize Technology

Leverage technology (tele-health; virtual webinars; use of social media) to increase access to care and overcome barriers to access in areas that are without providers and improve educational opportunities.  This use of technology expands access to doctors, specialists, etc. Use potential funding resources to provide equipment to use at home to improve telehealth (i.e. Novant Tyto-care Kit: Pieces of equipment provided to the patient that connect to app on phone and enable more productive telehealth visits (ear infections, viruses, etc.).

Community Partnerships

Partner with established groups like non-profits, sports teams, etc. to promote services and engage participants to educate them about preventative health screenings and wellness services. Develop medical satellite facilities in medically underserved areas of the County. Increase and improve effective and efficient communication between community agencies in order to meet medical & social needs of our most vulnerable communities and groups, including Veterans’ Services.

Mobile Units

Provide mobile units to go into under-served areas (parks, community centers, churches, colleges, and public and charter schools) and provide care (flu-shots, primary care, dental, and health education and screenings).

Medicaid Expansion

Advocate for Medicaid expansion in to bring more of tax dollars into NC, expand access for working North Carolinians, and reduce state costs for treating the uninsured.  

Transportation Modifications

Provide unlimited transportation services for vulnerable populations with established routes that include medical facilities & pharmacies.

Recruitment of Physicians and Specialists

Attract more primary physicians and specialists to our community (Hospital systems) so that we have an increased supply in our community, especially in rural areas of the county.

Best Practices

Telehealth/Teletherapy

As per the CDC, changes in the way that health care is delivered during this pandemic were needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Telehealth – the use of communication and information technologies to access health care services remotely– has provided a great benefit to many patients. Not only does telehealth bring healthcare services to you at any moment, but also it addresses the scarcity of providers in remote areas, the lack of proximity to health care facilities, the restricting schedule, and the unreasonable cost. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care.

Mobile Unit Model

Isolation from assistance prevents individuals and families from accessing needed care and community supports. Mobile units, which can be converted vans or small trucks, are used by health clinics and health departments to provide services to hard-to-reach populations. Populations that may benefit from mobile units include:

• people who lack transportation services
• isolated populations
• students
• and people who cannot easily leave their place of employment during business hours

Services that are provided by mobile units include health screenings, dental services, or benefits enrollment. 

Primary Care Behavioral Health Model

Integrating behavioral health into primary care settings is a common services integration model. Separate physical and behavioral health systems can lead to fragmented care delivery, poor health outcomes, higher healthcare costs, and duplication of services. Behavioral health integration can increase access to behavioral health services for rural residents, reduce the stigma associated with seeking these services, and maximize resources.

Prevention and Community Education

Mental health conditions and serious mental illness are impacted by a variety of factors. Change in the perception of mental health often starts with individuals; moves to families, the workplace, and schools; and ends with community leaders who are then equipped to maintain formal and informal community education efforts surrounding mental health. Prevention measures in community settings can help to support individuals at risk of or living with mental health conditions. Community members should be educated about the importance of treatment and prevention. Community education can help to reduce stigma surrounding mental health conditions and promote a positive mental health environment. Change in the perception of mental health often starts with individuals; moves to families, the workplace, and schools; and ends with community leaders who are then equipped to maintain formal and informal community education efforts surrounding mental health.