Nineteen years ago, after medical school at Columbia University; a stint
at Montefiore Medical Center, in the Bronx; and a period running
homeless shelters in Times Square; Karen Kinsell moved to Fort Gaines, a
tiny town in southwest Georgia, on the Alabama line. Fort Gaines is in
Clay County, which is consistently ranked among the poorest of the
hundred and fifty-nine counties in the state. It currently ranks
third-to-last in “health outcomes,” according to the Robert Wood Johnson Foundation,
up from dead last. Clay County’s only hospital closed its doors in 1983,
long before Kinsell, who is now in her sixties, arrived and became its
only doctor. “It’s a bad place to live,” Kinsell said recently by phone,
between seeing patients, “which is why I moved here. I was looking for a
place that needed me.”
Kinsell runs Clay County Medical Center, a facility with four exam rooms
built out of a former Tastee-Freez. It’s a private practice, but she is
a full-time volunteer. There is a receptionist and two other full-time
staff members; they see “around thirty to thirty-five patients a day,” Kinsell
said. Monty Veazey, the president of the Georgia Alliance of Community
Hospitals, told me that “Kinsellcare” is the only health care that’s
had a meaningful and positive effect here. “She’s going bankrupt
treating everyone that comes in,” he said. “Most have no
money, no Internet access, no other basic care. Many don’t have
insurance. How much longer can she do that? I don’t know. But she’s
their only hope.”
On Tuesday, shortly before Senator Mitch McConnell announced a delay in
the vote for the Senate Republicans’ health-care reform bill, Kinsell
spoke by phone about the effects of Obamacare, the prospect of
Trumpcare, and the plight of sick people in southwest Georgia. Her
account has been edited and condensed.
“My patients are sixty per cent black and forty per cent white.
Forty per cent are completely uninsured, and we just ask them for ten
dollars to cover the visit. If they can’t pay, then it’s free. We do
that because this is one of the poorest places in Georgia, with some of
the sickest people, and we’re adjoined by counties that are just as bad.
“We’ve had two rural hospitals in the wider area close in the last seven
years. And the quality of the remaining really rural hospitals is pretty
awful. You have to go in one of five directions to find health care from
here: there’s a physician’s assistant in a waiting room twenty miles
away. But the closest real hospital is thirty miles. A real regional
hospital is sixty miles away if you stay in Georgia, forty miles away in
Alabama.
“Many charge a minimum of twenty-five dollars. But we have a fair number
of people who live off food stamps, live off a hundred and ninety-four
dollars a month, live with family. They cannot afford that. So people
drive forty miles or more to see me. Few make appointments; many don’t
know in advance when they’ll be able to get a ride. No one is told
they’ll have to wait two weeks to see the doctor, but sometimes they’ll
sit here and choose to wait several hours.
“I’m the only provider in the county, so it’s partly chronic care and
partly urgent care that I do. There’s very high rates of diabetes,
hypertension, cardiovascular disease. That sort of thing. We just did an
S.T.D. check. I have leg pain reported in this next patient this
morning. We have a very high rate of elderly and disabled people here,
because of multi-generational poverty. People who can leave have left.
“Most people are so poor and kind of out of it that they don’t expect
anything. They mostly just expect to not have insurance. This morning,
we had a lady with post-menopausal bleeding, which could be cancer. The
absolute best thing to do is have her checked out by a gynecologist, but
we really don’t have a way to do that that she can afford. The health
department has some programs, but they generally require a diagnosis of
cancer before their programs can pick up. So that’s a problem. People
constantly have a problem being able to afford their medicines. I use
generics all the time. And prescription-assistance programs, which are a
tremendous amount of paperwork, which people have trouble doing. We use
samples from drug reps.
“There’s no mental-health care in the county, which is crazy. I just had
an eighteen-year-old who needed some mental-health medications renewed,
so I did that. There just isn’t what you’d expect to have in America
down here.
“In all fairness, Obamacare, as much as I was for it—and I’m on it
myself—didn’t affect us much at all. The first year it came out,
southwest Georgia had the second-highest premium costs in the nation,
after Vail, Colorado. And because not many people make enough to be
allowed to buy into it, very few people around here signed up for it. We
also were not allowed to be a provider, because people were allowed to
pick and choose providers. Then, of course, Georgia did not expand
Medicaid. That’s why about forty per cent of our patients are uninsured.
“We didn’t see a whole lot of businesses here starting to offer
insurance under Obamacare. Partly because the big companies—the chicken
plant—already have insurance. And we don’t have many companies that are
that fifty-to-one-hundred-employee size that would have been affected.
“With Trumpcare, we’d be going from bad to slightly worse, especially
with the proposed Medicaid limits. There’s talk of, down the road,
pregnant women might not be covered. Disabled people, too. Reduced
special services. We’d have more limited funding. We have a private
sixty-bed nursing home here in Fort Gaines, around the corner, and I
gather that ninety-five per cent are Medicaid patients. There’s only one
person paying cash there. There’s no financial reason why there should
be health care in Clay County.
“People who are politically active and educated are generally pretty
upset about the state of health care in this county. I had a wealthy,
Trump-supporting retired pathologist tell me, ‘Shoot, we need a
single-payer system.’ I was surprised to hear him say that. But the low
levels of literacy and engagement of people here—I think a lot of them
just aren’t even aware of these discussions going on. The uninsured
don’t have anything or expect to get anything.
“The uncertainty of whether Trumpcare will or won’t pass is disturbing
for us at the medical center, though. I expect, if it goes through, we’ll
have more patients come in for the free or discounted health care. And
we don’t have any more capacity. I’m here until 7 P.M. every night as it
is. It’s just, how much more can you do?”