The voice on the phone sounded doubtful and concerned. “But will you really be able to help me? My son told me that your services are only for indigent people.”
I paused for a moment and reflected on the word indigent, thinking of an appropriate response to her blameless question. Based on our fifteen-minute conversation, it seemed as though this woman had never requested this type of assistance. She was living off her monthly Social Security check of about $1,800 in order to pay for her mortgage, utilities, car insurance, cable television, and more. She had Medicare with a supplemental insurance plan that provided prescription drug coverage. Yet, this woman was seeking assistance with her prescription medications due to high copayment costs.
“No,” I sighed, “that’s a common misconception. We serve anybody as long as they exhibit the need. You just need to show us that your income and expenses balance out.”
I neglected to mention that for our Charitable Pharmacy’s Patient Assistance Program, clients must have a gross income that is within 200% of the federal poverty line. Did this woman know she was technically below 200% of the federal poverty line? Based on the 2014 paperwork, in order to be below that threshold, a single-individual household must earn less than $1,945 on a monthly basis; and for a household with two individuals, that number is $2,622. For each additional household member, $677 is added to that.
Each year, the United States Census Bureau collects data and determines the appropriate measures of need. According to their website, if total family income is less than the threshold appropriate for that household size, the family is in poverty. If the family income is above the threshold, then they are not considered to be in poverty by those standards. Of course, life is not this simple. Poverty presents itself in all forms. It does not obey statistical rules and measures along a straightforward line. Poverty dances all over that line, twisting over and above then waltzing below and behind. It shows up unannounced and refuses to leave. And for our clients at St. Vincent de Paul, it is often inescapable.
Before beginning my year of service with VVC, I thought “poverty” conveyed a sense of absolute despondency. The word would evoke visions of people in tattered clothing surviving with rumbling bellies and cardboard shelters. My experiences throughout these initial months of service have modified my interpretations of poverty. As a group of volunteers, we have been consciously aware of the vocabulary used in these situations. Rather than refer to “the poor,” it is more appropriate to say “people living in poverty,” “people in need,” “those who are made poor,” “underserved,” etc. In the Charitable Pharmacy, it is particularly important to value humanity itself before the condition because the levels of need vary so greatly.
On a typical morning, I meet with a client who was recently released from prison. As a returning citizen, he has no income and almost no belongings. He probably lacks any familial support, but at least his transitional housing program prevents him from truly being homeless. Aside from free prescription medication, this patient also receives vouchers to redeem for a birth certificate, an identification card, and clothing and household items. He also receives a snack bag, personal care items, and bus tickets. Throughout the interview, we connect on a few shared interests and laugh at each other’s jokes. Several minutes later, I sit down for my next appointment. I meet with an elderly husband and wife who are having trouble with medication copays. They each receive monthly Social Security checks, amounting to about $2,400. They have a home, a car, cellular phones, satellite television, and decent health insurance. They tell me stories about the previous weekend spent with the grandchildren. Although this couple struggles to pay for all of their bills and incidental expenses, their life seems plentiful. It is full of love, family, and an interesting story. Furthermore, they are able to maintain certain worldly possessions that society deems as essential for a normal functioning life.
Despite the stark differences among pharmacy clients, they are often lumped together as “indigents.” Honestly, I had never heard the word utilized before beginning my work in the pharmacy. Many of our operations are funded by the Hamilton County Indigent Care Levy and several outreach documents intended for physicians’ offices reflect that terminology. According to dictionary.com, indigent means: lacking food, clothing, and other necessities of life because of poverty; needy; poor; impoverished. Although this definition is quite simple, I find the connotation to be problematic, as do several of my colleagues. This type of terminology brings necessity to the forefront and leaves behind some dignity and respect. The best we can do at this point is slowly inspire change by bringing humanity to the forefront, perhaps by recognizing that they are underserved rather than indigent. We acknowledge and appreciate the diversity of clients that we serve on a daily basis. Regardless of each unique and complex situation, every one of our clients wants someone to listen and someone to pray for them.
It is remarkable how the healthcare system brings such diverse people to a level playing field. Because of the flaws in the system, someone who is homeless and unemployed has something in common with a person who earns $2,000 per month; neither patient can afford to purchase prescription medication. The public sector focuses on providing free health care through clinics and financial aid, but prescription costs are forgotten. I feel blessed to work in a position that helps underserved patients access free prescription medication. For many, it is a precious opportunity to improve and maintain their health no matter where they stand in relation to poverty thresholds.
Andrea is a current member with the Vincentian Volunteers of Cincinnati working in the Charitable Pharmacy of St. Vincent de Paul. In her spare time, she enjoys exploring Cincinnati’s art museums and learning to play the drums. She looks forward to a future of serving patients as a physician.