Colorado is joining about a dozen other states that are not requiring health insurance companies to revive canceled health plans.
No one mentioned cancellation notices. And no one expressed concerns about costs. Instead, at a sparsely attended public meeting about health insurance issues Tuesday evening, potential customers wanted to know if they could skip filling out Colorado’s complex Medicaid application.
Health exchange board members on Monday pressed for immediate improvements to Colorado’s mandatory Medicaid application, but state officials, who contend that Colorado is a “shining example” among the states, refused to promise that a full slate of short-term fixes will be completed before Dec. 15.
Colorado has no quick fix for a seemingly endless Medicaid application that health exchange board members believe is driving away customers and decreasing the number of people buying health insurance through Colorado’s new multi-million dollar health exchange.
In Choosing Wisely, physicians across the spectrum of medical specialties nationwide have created lists of procedures, tests and drug treatments that deserve second thoughts before doctors order them or patients accept them.
From 'Fear and Loathing' to Comfort and Healing
A report by Health Policy Solutions.
By Katie Kerwin McCrimmon
WOODY CREEK — The health clinic started in the famous Woody Creek Tavern near Aspen where gonzo journalist Hunter S. Thompson held court and sometimes packed his pistol.
“Hunter shot me in the tavern once,” says Gaylord Guenin, 77, Woody Creek’s sage, resident historian, writer, former bartender and current football pool manager. “We were arguing over who ruined the Tavern.”
That was years before any patrons wanted their vitals checked at the bar.
“Hunter unfortunately never took part in the clinic as far as I know,” Guenin says. “I have a feeling he would have supported it. Hunter came down on the side of justice in almost everything.
“That’s one of the nice things about this clinic. It’s all-inclusive. It doesn’t make any difference who you are and what you have. You can have a lot and you can have nothing. It doesn’t matter. You’re welcome here.”
Aspen, of course, is the ultimate land of the haves where Hollywood glitterati mix with titans of industry in spiffy Victorians and trophy castles that hug the ridges of Red Mountain or aptly named Castle Creek Canyon. But, there are many have-nots in the Roaring Fork River Valley as well. (Click here to read Solutions’s earlier coverage: Posh Aspen provides dismal health coverage.)
Beyond the groves of aspen and pine trees, in pockets along the river, trailer parks hide below ostentatious mountain homes. They are full of the workers, firefighters and aging hippies who make the local economy function. Many do not have health insurance and simply go without care until they get sick.
Enter Peg O’Brien, a physical therapist, who lives in Woody Creek’s trailer park, which in the last few years has proudly evolved into its own subdivision.
“She’s our Florence Nightingale,” Guenin says with a raspy laugh. (Despite O’Brien’s gentle advice to give up smoking, Guenin resumed his evening habit when the economy tanked.)
O’Brien has lived in the area for over 20 years and moved to the trailer park in 2004. There she met many older men who had moved to Aspen in the ’60s or ’70s. Some were ski bums. Others moved there to change the world. They stayed. They aged. And, some developed health problems.
“Many may not be connected to their families back east. They may not have insurance. Most don’t. Most of the residents are self-employed or work different part-time jobs and are not covered by insurance through work. Or others are facing the decision of dropping their health insurance because they can’t afford it. With that comes anxiety,” said O’Brien.
“The other thing I saw, along with health needs, was a lack of affordability and access to health care. It was too intimidating, so they avoided it.”
As a kindness to her neighbors, O’Brien began doing informal health checks in the Tavern, which is a short stroll from the trailer park. The local guys tend to show up there for lunch. Like the turkey vultures who hang out on the fence outside the bar, the wise-cracking locals line up on their bar stools at around 11 a.m.
Back in 2006, one of them asked O’Brien if he should bother to quit smoking. She knew a lecture wouldn’t work.
“I was trying to have a really open mind, so I said, ‘Let’s see if smoking agrees with you,’” O’Brien said.
She met him at the bar, pulled out a blood pressure cuff and an oximeter, a machine that measures oxygen saturation levels. The results showed that quitting smoking would indeed boost his health.
“Of course then, everybody wanted theirs done too,” she said.
With that first informal exam, a new concept was born: tavern medicine. Instead of a conservative doctor’s bag, O’Brien carries a colorful Grateful Dead tote bag.
She soon found that many of the men hadn’t seen a doctor in decades. One was using nicotine gum to give up smoking. But he was popping the gum like Chiclets.
“His blood pressure was through the roof. All he had to do was cut that. He just didn’t know. Everybody at the bar soon learned that you can really chew too much of that nicotine gum.”
Proud, aging ski bums discovered they needed health care
Peg became like Joel Fleischman, the town doctor on “Northern Exposure,” the quirky 1990s TV show about small-town Alaska.
From the Woody Creek Post Office to her front door late at night, O’Brien fielded questions big and small. Some women confided about domestic abuse. Other residents had less serious questions.
“People were asking me on the street about their elbow or their back,” O’Brien recalled.
“It’s pretty fun and really effective because you’re right there,” O’Brien said. “I’ve had 25 years of experience in conventional health care working with primary care providers, home health and in outpatient settings.”
But she discovered a powerful need for people to get care where they feel most comfortable, in their neighborhood.
The residents of the Woody Creek Mobile Home Association had been renters for years. When the association converted to a subdivision, a local nonprofit, The Manuas Fund, partnered with the Community Banks of Colorado and the Home Owner Association Board to make sure that every resident was able to buy and stay in their property. Then, economic disaster hit and some residents were struggling to pay bills and afford health care.
“They’re proud and independent. They didn’t accept help in the past. Now, with age and needs really becoming critical, they’re starting to open up more, especially with a local person they trust.”
By 2007, O’Brien decided to set up a more official clinic. Once a month, she brought her physical therapy exam table and set up shop in the refurbished log cabin that has become Woody Creek’s coffee shop and community center. It’s right next door to the Tavern. Click here to read Clinic offers care and coffee.)
“I sat for two hours once a month so people would know they were welcome to come with any questions. If they needed physical therapy, we could take care of it right then. If they needed to be referred, I could get them connected.”
She gave the advice and simple therapy for free as she was building her private practice, providing physical therapy to Aspenites in their homes. Providing free or low-cost care to the regular folks who live “down-valley” gave O’Brien a balance to her patient load.
She then partnered with Mountain Family Health Centers, the safety net health center in Glenwood Springs, and arranged for cardiovascular screenings.
“About 20 (residents) had never before had their basic cardiovascular blood profile. Most had had almost no health care for decades. They were healthy men and women, mostly men, who came out here as athletes and worked to support their skiing. Now they’re in their 50s, 60s and 70s.”
After discovering the need, O’Brien began reaching out to partners including the Aspen Valley Medical Foundation, The Manaus Fund and the Thrift Shop of Aspen. Leadership and support has come from George and Patti Stranahan, mountaineers, who founded the Woody Creek Tavern, Flying Dog Brewery and Stranahan’s Colorado Whiskey.
The Stranahans, who also were friends and neighbors of Hunter Thompson, created their Carbondale-based nonprofit to promote social entrepreneurship. The Manaus Fund is named for a city in Brazil where the Amazon and Rio Negro rivers flow separately for miles before blending together. The Stranahans wanted to do good by bringing business savvy to the nonprofit world, thus joining two distinct worlds. They donated the space for the community center and have supported the clinic.
‘People just live with illness’
As the health needs grew, O’Brien’s private practice was also expanding. So, The Manaus Fund and other anonymous donors arranged for a formal director. O’Brien still participates in the clinic every month, but Sarah Kuhn is now program director.
A former Peace Corps worker, Kuhn worked in community health in Cameroon. She has found interesting parallels between Aspen and Africa. In both places, people are concerned about the expense of seeing a doctor.
“That’s the same here. It’s not accessible to everyone,” she said. “You realize that health is such a primary need for people. You take it for granted when you’re in good health. But most people would rank it very high in terms or priorities.”
Kuhn is beginning to collect data from the clinics so she can better understand the needs in the community. At the August clinic, for instance, all of the 16 patients who were seen that morning filled out a survey. More than half, or 56 percent, said their annual income was less than $35,000 a year. More than a third, nearly 38 percent, had no health insurance. A similar percentage had private insurance while others had Medicare or insurance through the veteran’s administration.
Everyone is welcome at the clinic regardless of income. Kuhn is eager to build the number of patients seen.
“I want to reach the people who are really in need. People are starting to know about it, but I want to reach the ones who don’t get check-ups, who are not actively seeking health care.”
Ironically, among immigrants, outreach workers have found some skepticism because the clinic is free.
“People are asking, ‘Why is it free? It must not be licensed doctors.’’’
In addition, the community center is about 2 ½ miles off Colorado Highway 82. While that’s not far, it may be too distant for low-income people who rely solely on the buses that run up and down the valley from Glenwood Springs to Aspen.
Kuhn is working to build the Woody Creek clinic, then will consider expanding it elsewhere in the valley.
“We’re trying to make a big push to connect with other health and human services organizations and collaborate on joint campaigns. Maybe a busload of seniors would come here sometime.”
Janeth Niebla, a community organizer for The Manaus Fund, attended the last Woody Creek clinic so she could translate for any Spanish speakers and because she’s interested in duplicating the concept in other trailer parks.
Through surveys and outreach efforts in the Roaring Fork Valley, Niebla has found that even visiting a low-income clinic is challenging for some immigrant workers.
“They have to save up to go for an annual checkup. If it costs $200 or $300, it’s still something they can’t afford.”
Plus, time is scarce.
“It’s (lack of) insurance. It’s money. It’s time. Finding the time to do anything is hard.”
What she loves about the Woody Creek clinic is its accessibility and the comfort factor.
“People can walk. It’s free. It’s easy. We’d love to take this to other trailer parks.”
Niebla grew up in Glenwood Springs and has witnessed the growth in population of workers from Mexico and Central America.
“What we see is a population of really wealthy people here and a population of low-income people. There are both extremes and not much in the middle.
“People tell us they don’t have health insurance. They don’t have a lot of benefits. They just live with illness,” Niebla said.
Connections critical in accepting care
Sitting on his favorite bar stool at the Woody Creek Tavern, Gaylord Guenin draws NFL team names for the week’s football pool as the bartender records his picks on a dry-erase board. He won last week’s pool, collects his $300 and quickly hands the young woman a $20 tip.
The tiny tavern is still filled with photos of celebrities and Hunter Thompson memorabilia. Although he killed himself in 2005, Thompson’s anti-authoritarian philosophy is still alive and kicking here.
The heyday of the bar was in the early 1980s when it was a real Wild West tavern where locals mixed with ranch hands and Hollywood stars could duck in for a drink without being bothered.
As the popularity of the place grew, Thompson was convinced that it wasn’t the same any more. He and Guenin had an ongoing debate over who had caused the demise of the Tavern. Guenin argued that Thompson’s attention-seeking books were destroying Woody Creek. Thompson ripped on Guenin for selling Tavern T-shirts.
“We had a sign in the Tavern that said, ‘It’s not who you are that’s important. It’s how you conduct yourself.’”
One night, Thompson came in and started screaming at Guenin.
“You’ve ruined the Tavern,” he shouted. “Then, he pulled out a pistol and he shot at me. The amazing thing was I wasn’t the least bit concerned. It was hilarious. I might have been in shock or on drugs.
“We were good friends, but he was crazy.”
The noisy round turned out to be a blank. Both men survived and so did their friendship.
Today, Guenin has had to cope with the loss of four or five close friends. He lives in Lenado, an old logging encampment several miles in the mountains above Woody Creek. George Stranahan bought all the land and gave several old-timers deeds to cabins they had been renting.
Guenin has never had a job with health insurance. He’s on Medicare now and is grateful to O’Brien for helping him navigate the health care system.
“When you go to her, she’s a sounding board. Or you have these doctors come in here and you can talk with them.”
Peg O’Brien tries to make sure that the “turkey vultures” from the tavern, or her firefighter neighbors or the new immigrants who are cleaning hotel rooms and working in restaurant kitchens all have access to care.
Perhaps she gets her calling from her mother who’s a parish nurse in Dubuque, Iowa. Or maybe she’s an Aspen transplant with a Midwest ethos. Regardless of her motivation, O’Brien wants to be sure that all people – insured or not – have someone keeping an eye out for them.
She saw one man at the August clinic who had a concerning skin condition on his back.
“It was changing and irregular. He lived alone so he couldn’t see it. He hadn’t seen a doctor in more than five years,” O’Brien said.
She urged him to make an appointment.
“You don’t have to be concerned yet, but check it out.”
From time to time, O’Brien ran into the man at the Post Office.
“Did you go yet?” she asked.
“Not yet,” he replied.
“It takes cajoling and support sometimes,” O’Brien said.
Finally after badgering the man a few more times, she got the right answer.
He had finally sought help.
Said O’Brien: “The more we develop these connections, the better health care we’ll have.”
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