MANATEE -- When she was 31, Manatee County resident Teresa Rivera, now 55, was diagnosed with an auto-immune condition called Hashimoto's Disease.
Simply put, her own immune system had been attacking her thyroid, the gland at the base of her neck which produces the hormones she needs to fuel the work of her other organs.
"I stay overweight, I stay cold. I have a hard time keeping my hair," Rivera said Saturday. "It took five doctors to figure out what I had. Some told me I was nuts. I ballooned up to 260 pounds. Finally, one doctor figured out what it was. He said I should have been in a coma."
Fortunately for Rivera, scientists have developed synthetic hormones that can do for Rivera what her thyroid once did. And the replacement hormone therapy is relatively cheap, a 90-day supply costs about $10, which Rivera can afford.
But what she can't afford with her part-time job is a doctor's visit or the twice-a-year blood lab work that costs $1,000 and is necessary to evaluate just what hormone replacement therapy she needs.
"The thyroid impacts cholesterol and so many other things," Rivera said. "It's a domino affect. Many tests need to be performed at the same time to give a broad picture of what is going on."
Rivera is one of several thousand Manatee County residents who, during fiscal year 2014, qualified for medical assistance from Manatee County's indigent care fund, used to supply medical care to people who don't have health insurance or the money to pay for health care.
For about 30 years, money to serve the indigent clients came from a fund that was established when Manatee Memorial Hospital was sold to a private company.
The fund will be exhausted Sept. 30, said Karen Windon, Manatee County deputy county administrator.
Now, Manatee County commissioners, government staff and private citizens are debating if, when and how to handle indigent care going forward.
They are essentially talking about Teresa Rivera and people like her.
Who qualifies for indigent care?
Rivera lost her high-paying job as a bookkeeper and her health insurance during the 2007 economic slump and, later, she said, her home.
"I went through $30,000 in savings trying to keep my home and credit," she said.
"I tried to get fast food jobs but they said, 'I can't hire you. You will apply with someone else and leave me,' " Rivera said.
Rivera finally found a position without health benefits as a part-time bookkeeper and secretary in Bradenton. She earns $14,000 annually. Single with no children, Rivera lives in an apartment.
"I don't want this to be a 'woe-is-me' tale," Rivera said. "I'm not broke. I'm doing OK. People like me are not truly indigent but we don't have enough to do it on our own. It is a gap and I don't know how to fix it."
She said she was declined when
she applied for insurance under the Affordable Care Act.
"I went to one of the kiosks and they said I didn't make enough to pay the lowest premium they would offer," Rivera said.
Knowing she needed a doctor to order her blood work, Rivera came to We Care Manatee's Primary Care Clinic in 2008.
We Care Manatee, 300 Riverside Drive E., Suite 2000, is a non-profit which, under Executive Director Jill Gass, has grown from 30 to 100 doctors who volunteer their services to Manatee County's needy.
Still a client of We Care Manatee after seven years, Rivera meets their following qualifications: she has no health insurance, she can show proof of Manatee County resident status, she is between 18 and 64-years-old and she currently earns less than $1,962 per month in gross pay as a single person, which is 200 percent of the federal poverty guidelines.
After seeing the We Care Manatee doctor for free, We Care Manatee also set her up with an appointment with a financial counselor at Manatee Memorial Hospital. When she went to MMH, Rivera carried with her a prescription from the We Care Manatee doctor for her lab work.
At the hospital she had to show proof of Manatee County residency, bank statements to show she didn't have money in the bank, a pay stub to prove her income level and to sign a statement that she didn't have Medicare or Medicaid, she said.
Once approved, Rivera was sent to the MMH lab and the results were sent back to We Care Manatee.
"Oh what a godsend," Rivera said of We Care Manatee. "They are very nice people and really take into consideration your position."
"I think Teresa is a great example of someone who was able to utilize the resources in the county," Gass said. "She is relatively low maintenance when it comes to maintaining her health. Without seeing the doctor twice a year she would show up in the emergency room very sick and it would cost a lot more money than a couple of medications and a lab visit."
A patchwork of help
We Care Manatee had 2,000 patient visits in 2014. The organization runs a annual budget of $380,000, which comes primarily from private grant sources and private and corporate donations, Gass said.
We Care Manatee has access to primary and specialty physicians as needed. The organization also provides pharmaceutical assistance, breast health and wellness services which include mammograms and a free vasectomy program, which began in 2014, Gass said.
"These are all the services we are able to provide due to the generosity of the volunteer physicians in our community," Gass said.
Windon believes most people in Manatee County want to help the working poor like Rivera, but how to raise about $9 million a year to fund the indigent care program is the question.
"I don't think anyone wants to see anyone suffer," Windon said. "We are a caring community."
The debate widened as commissioners wonder if the many health care providers in the county are duplicating efforts or if the taxpayers are getting a solid product for their money.
Some of the options, among others, for re-establishing the $9 million indigent fund include another attempt to implement a half-cent sales tax, an increase in property taxes or diverting funds from other programs in the county's general fund, Windon said.
We Care Manatee, Turning Points, Manatee County Rural Health and Manatee Glens are the so-called Big Four agencies that step into that so-called gap, said Gass, who believes Manatee County's medical infrastructure is not only working, but provides county residents a good bang for their buck, better even than nearby urbanized counties, which pay double or triple more.
"We refer with each other a lot," Gass said of the Big Four. "We all work together to provide services for the medically uninsured. I think there is always room for improvement but I think the community can trust that the health systems are working."
Gass said they work to ensure they are not duplicating services.
"For instance, if we see a patient who is complaining of seizures, then we send them to The Epilepsy Foundation in Manatee County," she said.
Rivera pictures Manatee's medical infrastructure as patches on a tire.
"All of these little patches add up to a big patch," she said. "It's not perfect but it works."
Rivera said the county needs to keep the indigent fund going.
"I think an awful lot of folks utilize that fund," Rivera said. "I don't know what it would take to replenish it. My mind thinks in terms of bake sales and car washes. I know how to bake cookies and I can wash a car."
Anyone who has questions about if they qualify for help or would like to make a donation is urged to contact We Care Manatee at 941-755-3952.
Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.