BRIDGETON, N.J. - Kimberly Bozearth cleans houses for a living, but can't afford health insurance to cover the cost of treating her high blood pressure.
Instead, the state pays most of the bill. The Fairfield Township resident picks up prescription drugs and receives checkups for just $20 a visit at a community medical center run by CompleteCare Health Network in Bridgeton.
Rural Cumberland County, where residents rank as New Jersey's poorest and most unhealthy, is especially reliant on the government's policy of reimbursing health centers for what is known as "uncompensated care." CompleteCare is among the busiest facilities of its kind statewide.
But the system, designed to help medically underserved populations, faces challenges.
Gov. Christie has proposed reducing community health centers' reimbursement rates for treatment of the uninsured by 10 percent at the very time they face increased demand because of the recession and budget cuts in other health programs for the needy.
The number of low-income uninsured patients whom the state has reimbursed the centers for treating statewide has risen 35 percent since 2007, to 178,775. Further increases are expected in the coming year.
Senate Health, Human Services, and Senior Citizens Committee Chairwoman Loretta Weinberg (D., Bergen) said lawmakers would oppose the reimbursement reduction in the coming budget, which must be approved by July 1.
"I'm truly concerned that if you put those together with the cuts in family planning [in 2010], we are cutting off access to health care for many, many working poor people," she said.
How New Jersey should most efficiently pay for medical treatment for the poor has been a difficult question in hard budget times.
People without insurance don't stop getting sick, and hospitals and other health centers are required to treat anyone who walks in regardless of his or her ability to pay.
So it saves society money, health experts say, to provide access to earlier care to prevent people from developing serious medical conditions, becoming disabled, or giving birth to unhealthy or premature babies. Healthy people, so the reasoning goes, are working and paying taxes.
Federally Qualified Health Centers, such as CompleteCare, function as a kind of social safety net for low-income people. They offer primary care and try to prevent uninsured people from making costly and unnecessary trips to emergency rooms.
The state has 20 FQHCs. Surviving on federal and state government support, they received 1.3 million patient visits last year, according to the New Jersey Primary Care Association.
The third busiest is CompleteCare, which serves mostly Cumberland County but also sees patients from Gloucester and Cape May Counties.
Many of the people who walk into CompleteCare, headquartered in Bridgeton, are the farm laborers, landscapers, retail employees, and construction workers who fuel the local economy but don't receive health insurance through their jobs. Others are unemployed; the county's jobless rate is nearly 15 percent, the second highest in New Jersey.
Thirty-seven percent of the patients seen by CompleteCare have no insurance. They are charged on a sliding scale based on what they can afford; the average co-pay is $5. The state reimburses the facility $101 for every uninsured visit by people such as Bozearth.
"People like us need places to be able to go," she said.
Without low-cost care, Bozearth added, she probably wouldn't go to the doctor at all.
Another beneficiary is Zara Miguel, a migrant farmworker from Mexico who had no medical insurance for the back pain she endured picking vegetables here, or the dry, itchy eyes she suffered from spraying pesticide.
There's also Joseph Evans, who has hypertension and leg pains from a career of truck driving. He started going to the center after leaving his job because of medical problems, then lost his health insurance.
An additional 45 percent of the patients pay with Medicaid, for which reimbursement is so low that few health providers in the region accept it.
Colleen Yeager goes to the center to get treatment for her diabetes. The single mother makes $7.80 an hour at Wendy's and has had a hard time getting anyone but CompleteCare to accept her Medicaid.
It's hard to find a job that pays decently in the county, she said, or offers health benefits.
"We have no economy here. . . . It's really dead," Yeager said.
In recent years, South Jersey Healthcare has been directing patients in its hospitals in Cumberland County to CompleteCare to set up appointments if they lack insurance and don't have a primary-care doctor.
The hospitals still get a good number of emergency-room visits "for things that are not necessarily an emergency but something that could be handled through a primary-care physician," said Scott Wagner, chairman of emergency medicine for South Jersey Healthcare.
"A lot of times, it's because the patients don't know where to turn, and the emergency room is an easy place to turn, but not always the best choice for long-term care or preventative-type health care," he said.
'Not good economics'
CompleteCare president and chief executive Gil Walter said the proposed cut in reimbursements "is not good economics."
Access to health care keeps people working instead of becoming sick and dependent on government assistance, he said.
"You can't stop [people] from being human. . . . If you don't have health support, you have sick babies, sick women," Walter said.
If you don't pay now, he said, you pay more later.
Walter said CompleteCare had already had a 10 percent increase in patients this year at its 18 offices.
CompleteCare projects a deficit of $449,820 with the reduced reimbursement, meaning it could support 4,500 fewer patients. The center could dip into reserves and close locations, Walter said.
Dawn Thomas, a spokeswoman for the state Department of Health and Senior Services, wrote in an e-mail that the agency had invested money in FQHCs from 2004 to 2009 to provide extended hours, renovate facilities, lease new delivery sites, and add clinical staff.
The department is proposing a reduction in reimbursement now to allow the health centers to maximize the number of patients they serve, Thomas wrote. But overall funding for the program will increase 4.5 percent to $41.8 million, she added.
Half of the state's health centers are losing money, according to the New Jersey Primary Care Association, which argued before legislators that the centers could not absorb funding cuts with so many visitors.
New Jersey already spends a staggering amount on health care for its neediest citizens.
The state will spend about $10 billion this year - roughly half of that from the federal government - on Medicaid, the health-insurance program for low-income and disabled people. It will also pay $665 million to reimburse hospitals for "charity care" to treat low-income patients who lack insurance. Christie increased charity care by $60 million in the current budget and is proposing to increase it again by $10 million.
An additional $40 million would go to reimburse FQHCs.
But the state has cut other categories of health care.
To help plug a budget gap, the Christie administration last year dropped thousands of low-income adults from the FamilyCare insurance program. The governor also eliminated state funding for women's family planning centers last year - $7.5 million - which prompted some closings and reduced hours.
As those patients turn to FQHCs for their care, the State Parole Board has asked the centers to see more prisoners as they return to their communities, and state health officials have directed them to see more people with substance-abuse problems, said Kathy Grant-Davis, executive director of the New Jersey Primary Care Association.
Health centers also have seen a growing number of residents who lost their jobs - and health care - in the recession, Grant-Davis said.
"All of those patients were directed to us, but not with additional funding," she said.