2007 Spring, Pg. 65. MANCHESTER'S HEALTH CARE SAFETY NET INTACT BUT ENDANGERED.

• Author: By Dorothy A. Bazos, Ph.D. and Anna J. Thomas, MPH

New Hampshire Bar Journal

2007.

2007 Spring, Pg. 65.

MANCHESTER'S HEALTH CARE SAFETY NET INTACT BUT ENDANGERED

New Hampshire Bar JournalSpring 2007, Volume 48, No. 1Health Care & the LawMANCHESTER'S HEALTH CARE SAFETY NET "INTACT BUT ENDANGERED"By Dorothy A. Bazos, Ph.D. and Anna J. Thomas, MPHINTRODUCTION

There is a need for the development of an economically sustainable system of comprehensive coordinated primary care for Manchester's most vulnerable populations. The primary care delivery systems in this city are stressed, in large part from serving a growing population of persons who live in poverty, are uninsured, underinsured, or on Medicaid. Both Manchester residents and providers face increasing economic barriers for getting or providing appropriate health care services. Since no near-term relief from federal or state government sources is expected, the community has taken a proactive approach to health system reform and has established a community collaborative, the Manchester Sustainable Access Project (MSAP), to begin a planning process to evaluate and improve its current health delivery infrastructure.

SCOPE OF THE PROBLEM

The City of Manchester is the largest community in New Hampshire and in northern New England with a total population of 110,550 residents. Although Manchester is located in a predominantly rural and affluent state, it is an urban community with public health challenges and diverse demographics similar to those found in larger cities. The number and proportion of Medicaid enrollees, underinsured, and uninsured populations (including refugee, immigrant, and homeless populations) living in the Manchester area have grown substantially over the past several years and the current health care system has become inadequate for meeting the needs of these local residents in a financially sustainable way.

Manchester's poverty rates are high and are growing as illustrated by the table below. In 2005, over 14,000 Manchester residents, including 22 percent of Manchester's children, lived below the federal poverty level.(fn1) It is estimated that 28,000 residents - about 25 percent of Manchester's population - currently have incomes below 200 percent of the federal poverty level.(fn2)

As the city's poverty rates have increased, so has the number of residents who are enrolled in Medicaid, uninsured or underinsured. Manchester is now home to a disproportionate share both of the state's Medicaid recipients and uninsured. While about 8 percent of the state's population lives in Manchester, 15 percent of the state's Medicaid enrollees and in 1999, 14.6 percent of the state's uninsured, claimed Greater Manchester as their home. Subsequently, more Medicaid enrollees and uninsured residents are being seen by local providers as a proportion of...