Reno is a National Model for Addressing Community Health

By Luka Starmer

Once or twice a week, a man named Elmer sits and enjoys a cerveza in the same seat near the window at Asi Es Mi Tierra, a Mexican/El Salvadorian restaurant on Wells Avenue in Reno. Elmer is undocumented. His story of entry into the United States is harrowing. He left his wife and daughters behind, taking an expensive illegal boat ride to Texas from Guatemala with his brother. From there, they crossed the Chihuahuan Desert in the southern United States, working their way to the West. The long, harsh mission took his brother’s life and left Elmer alone to trek the remainder of the journey until finally making residence in the Biggest Little City.

“Anything is better than where I was,” he told us in Spanish, despite the reality that he will never return to his former home.

Elmer is in his late twenties, working construction in residential locations from Reno to Truckee. He is contentedly settled into his life here. He has a girlfriend who drops him off at his favorite spot to enjoy a bucket of beers and solemn contemplation.

But the balance of life is variable for Elmer and many other undocumented citizens in Washoe County.

In the 89502 zip code alone, the zip code where Elmer lives, approximately 8,500 people are not U.S. citizens. Nearly 40 percent of the Hispanic population lives below the poverty line. One in five residents is without health insurance.

These facts come from Reno-based organization Truckee Meadows Healthy Communities. Earlier this year, the organization generated a report identifying community health needs specifically in the 89502 zip code, home to the largest concentration of Hispanics in the area.

“The report shows that there’s not enough here for the Latino community,” said Oscar Delgado, member of Truckee Meadows Healthy Communities.

Delgado is Reno councilman of Ward 3 containing 89502. His goal is to continue to bring together more community stakeholders to address the needs identified in the 89502 report.

Last year, Elmer broke his collarbone falling from a ladder on the job. His illegal residential status and his limitations with the English language daunted him from visiting a medical facility like Renown or Saint Mary’s.

“Because they don’t have health insurance, and they don’t know how much it costs, people end up going to a masajeador, which is massage therapist in Spanish,” explained Jackie Gonzalez, Outreach Coordinator at Access to Healthcare Network, a Nevada-based nonprofit that addresses healthcare concerns for uninsured and low wage populations. “They use funky herbs they make at home, and they massage it on their legs. They do their own bandaging. Some people swear by it.”

These techniques are similar to the way Elmer coped with his injury.

“I went to a Mexican near San Francisco,” he said.

The unlicensed backroom doctor reset Elmer’s collarbone. He was back to work on the jobsite in a matter of weeks.

Even for documented Hispanics, there is a general mistrust towards the American healthcare system. Since implementation of the Affordable Care Act (Obamacare), there’s still confusion about how, exactly, health insurance works, or the best ways to navigate the occasionally convoluted but legally mandatory options available.

Take Mary Alvarado, for example. She’s the owner of Belleza Para Ti hair salon on Wells Avenue. She and her family are documented and have health insurance coverage through Medicaid, but this doesn’t bring Mary peace of mind.

“For me, I’m crossing my fingers, praying, that I don’t get sick. Just to think about going to the ER or to a dentist is way too expensive for us,” she said.

Like Elmer, she prefers home remedies and over the counter medicine to combat common illnesses. She chooses to wait to get dental checkups for years until she makes the long trip to her home country of El Salvador to visit family.

“As I hear from different people I see here, they feel the same about medical or dental or any surgery. That’s why I think a lot of people get diagnosed with illnesses because they wait too long. They’re just too horrified to deal with the [financial] consequences after seeing a doctor,” said Alvarado.

Reno, however, is home to a unique nonprofit in the healthcare realm: Access to Healthcare Network, where Jackie Gonzalez works. The organization, conveniently located on Wells Avenue, increases access to primary and specialty healthcare for uninsured and low income Nevadans. For undocumented citizens who are not eligible for the health insurance under Obamacare, Access to Healthcare Network collaborates with various healthcare providers in the area who agree to accept and treat these populations at discounted prices. This program service, known as the Medical Discount Program, costs $35 per month for its members, plus small copays.

Gonzalez shared the story of a client who didn’t have health insurance, but was visiting Renown frequently because of breast cancer. She had accrued approximately $300,000 in medical bills before calling Access to Healthcare Network. The organization was able to renegotiate bills and provide the financial assistance that brought her out-of-pocket expenses down to $1,500.

“It had a big impact in her life and her family’s life financially and emotionally,” said Gonzalez. “If she didn’t have Access to Healthcare, she would have to pay that $300,000.”

Nationwide, city and state officials are seeking to identify and establish fair and sustainable strategies to responsibly cope with large uninsured populations. Individual for-profit and nonprofit hospital systems contain their own policies, but initiating a reliable system for uninsured and undocumented citizens on a state-wide scale is unprecedented outside of Nevada.

According to Jackie Gonzalez, Access to Healthcare Network CEO Sherri Rice is currently consulting with organizations in California and North Carolina where undocumented populations are high.

Another client of Access to Healthcare Network is a collaborative project between the New York Immigration Committee and the Hastings Center, a nonpartisan bioethics research group. In April 2015 they submitted formal recommendations addressed to the Office of the Mayor of New York City. Their 20-page report asserted that, “Nevada is distinctive [from the other programs included in the research] as a discount program with a broader range of providers.”

“They’re now implementing a lot of how we work with our Medical Discount Plan in New York,” Gonzalez said.

Despite the industry applause, the 89502 report from Truckee Meadows Healthy Communities notes that healthcare services are only one factor determining the overall health of a community. Housing, job availability and good wages, transportation and education are among other determinants of community health.

John Packham, Ph.D., director of health policy research at the University of Nevada School of Medicine, wrote in a November 2015 editorial in the Reno Gazette Journal:

“A culture of health requires a pursuit of innovative, broad-based collaboration among diverse public and private organizations who share the common goal of a healthier community.”

As Access to Healthcare Network and Truckee Meadows Healthy Communities strive to embody this, it seems that Reno may now begin to include “a culture of health” among the other cultural identifications that characterize the Biggest Little City.