Fannie Dorsey lives and works in Vicksburg, but a big part of her life is playing out on the congressional battlefield that is the current state of American health care reform.

Dorsey, 54, has worked for years full-time at Taco Casa, a small business that, like many across Vicksburg and the nation, provides no health insurance for its employees. She has high blood pressure and acid reflux, requiring three medications and regular doctor visits, which she gets at the monthly First Baptist Church free medical clinic. Dorsey said she doesn’t know what she’d do without it.

“With the high cost of medicine, I don’t know how I’d pay for it,” Dorsey said. “A lot of people are in the same boat and don’t have insurance. Are they going to be stuck between whether they can afford insurance or afford to eat?”

Another free clinic is open twice a week at Good

Shepherd Community Center on Cherry Street.

“It means everything to us,” said Tina Swilley, waiting to see a doctor at Good Shepherd. “It means I have some way to get care. Without it I could not afford my medicine.”

Swilley, 53, takes medication for high blood pressure and allergies and in July received treatment and antibiotics for infected varicose veins. A “stay-at-home grandma and homemaker,” Swilley has worked outside the home, but not enough to qualify for disability. Her husband, Wayne, is retired and has Medicare and Social Security benefits.

The clinics at Good Shepherd and First Baptist provide basic exams and blood pressure and glucose monitoring. They have pharmacies with certain medications — no narcotics are prescribed or stored in the clinics.

In addition, the First Baptist clinic provides laboratory tests, nutritional and spiritual counseling and limited dental care. For more complicated procedures such as MRIs, a social worker helps make referrals and tries to obtain hardship-case free or reduced-cost treatment.

“University Medical Center will do them, but they have a backlog, and sometimes it’s hard for patients to get over there,” said Hester Pitts, the FBC lab director and one of the clinic’s prime movers. “The social worker will call around and see who can do the procedure for free.”

In addition to the free clinics, Vicksburg has two community health centers that operate on a sliding fee scale — the Vicksburg Warren Family Health Center on Mission Park Drive and Tri-County Health Group on Oak Street. Both centers operate under the umbrella of the Jackson-Hinds Comprehensive Health Center and offer a range of medical care and services for fees determined by income and family size.

“We are the safety net for the working poor,” said Dr. Jasmin Chapman, chief executive officer for the organization. “We consider ourselves the experts in the uninsured and underinsured.”

Each center has a family doctor, a pediatrician and a nurse practitioner on staff, and contracts with an obstetrician-gynecologist for women’s health care, including routine examinations and prenatal, delivery and postnatal care. They also provide discount medication, lab work, family-planning services, social workers for referrals and nutritional counseling and other instruction.

*

The number of Warren County residents without health insurance can only be estimated. The 2000 U.S. Census reported that 25 percent to 38 percent of people in the county had no health insurance, including such government-sponsored plans as  Medicaid or Medicare.

Statewide, an estimated 550 people each week lose their medical insurance coverage, reports Families USA, a nonprofit, non-partisan organization that calls itself “the voice for health care consumers.” That translates to an average of nearly 2,400 people each month and more than 28,000 each year.

The organization does not break down its figures to show how many of those people are in a temporary insurance bind, but it states that by December 2010, more than 85,000 Mississippians will have lost their health coverage in the three years since January 2008.

“Most of the time if people are laid off they have a right to stay on the old employer’s policy and pay the premium for a period of time,” said Cathy Vernon, director of consumer services at the Mississippi Department of Insurance. “But the premiums are so high, sometimes they have to make a choice between insurance and food on the table.”

Families USA points out that while the Consumer Price Index, measuring the prices of an array of products and services, rose 29.2 percent from 1999 to 2008, health insurance premiums increased 119 percent in the same period. Employers who are able to provide health insurance are paying at least 12 percent of payroll costs to do so.

*

First Baptist’s clinic was started by Dr. Daniel Edney, an internist, in 1997. “Our mission is directed at the working poor,” said Edney, whose practice moved from River Region Medical Center to Medical Associates of Vicksburg in 2008. “Those who are working hard for a living are doing the best they can, but their employers don’t provide insurance and there’s no way they can afford it.”

The clinic became so overcrowded, reaching 139 patients in March, it announced in June it would begin requiring proof that patients seeking care are not eligible for Medicare, Medicaid or private insurance. “We were just about overwhelmed,” Pitts said, with volunteers often not finishing until 11 or later at night.

Good Shepherd, which began its clinic in 1993, limits the number of patients per day to 12 to 20, depending on the physician on duty, said the Rev. Tommy Miller, Good Shepherd’s director. “Most of the people who come are here for checkups. Most have high blood pressure or diabetes and need medication.”

FBC’s stricter guidelines will take effect with this month’s clinic, on Aug. 20, though patient numbers were down to about 60 in July. Pitts blamed the decline on a misunderstanding or incomplete paperwork. “Our goal is to meet the needs of those who really need it,” she said. “We were having to go way too fast, almost running them through, and we felt bad.”

*

While the free clinics have seen an increase in patients, visits to the emergency room at River Region Medical Center have actually decreased, said marketing director Diane Gawronski.

In 2008, the hospital logged 34,342 visits, contrasted with 34,585 in 2007. Figures for 2009 were not available, and Gawronski did not know how many of those patients had or did not have medical insurance. “But we wrote off more than $30 million in uncompensated care in 2008,” she said. “That’s not ‘donated;’ that’s pure uncompensated care that we provided.”

The hospital also donates the lab services required by the FBC clinic patients, Pitts said.

Gawronski said that though the hospital tries to educate people on when it’s appropriate to go to the E.R. with a medical complaint, it’s clear that better routine medical care is needed.

“By the time people come here, they are often very sick,” she said.

*

The need for preventive care is not lost on those who can’t afford it.

One woman at FBC’s July clinic, diagnosed several months ago with diabetes, said that without insurance, it’s nearly impossible to see a doctor for annual checkups.

“I think we could do better,” she said of the current state of American medical care. “We do need more preventive care. With diabetes, for a long time you don’t know you have it. And then once you have it, it’s so expensive.”

Between her June and July visits to the monthly clinic, she said she got scared about her health and made an appointment at a Vicksburg medical center. Lab work was ordered for her and, based on the results, her medication was adjusted. She felt better, except for the $600 bill she’ll be paying on for a long time.

The scare did force her to get serious about what she eats and follow a strict diet.

The community health centers — Tri-County and Vicksburg Warren Family Health — offer the kind of check-ups that can catch diseases in the early stages or perhaps prevent them if patients do their part. Often that means eating healthier and exercising.

“You could cure yourself by getting to a normal weight,” said Dr. John C. Williams, one of the Good Shepherd doctors. “You don’t have to change your lifestyle. You just have to lose weight.”

Chapman said the centers emphasize prevention. “We offer a hypertension education and treatment program, a diabetic collaborative and other nutritional counseling.”

Dorsey said she has attended Good Shepherd’s nutritional counseling sessions and is applying what she learned there, limiting her salt intake and working to keep her blood pressure down.

Not everyone does, Williams said. “You tell them again,” he said. “You don’t give up. You keep trying to figure out some way to get ahead and keep battling.”

In the meantime, the nation’s doctors, legislators and president will keep trying to solve the insurance mess.

On Friday night, Democrats narrowly pushed sweeping legislation through the House Energy and Commerce Committee, a key congressional committee, clearing the way for a September showdown in the House, after lawmakers return from a monthlong vacation.

Edney, a member of the Mississippi State Medical Association board of delegates who went to Chicago to hear President Barack Obama speak on health care reform in June, is optimistic an answer will be found.

“Everybody agrees that the working poor have to be covered,” Edney said. “What we have now is unacceptable.”

*

The uninsured

Who are the uninsured? In 2007:

• 45.7 million Americans — 15.3 percent of the population — were uninsured at some point during the year, up from 44.8 million in 2005 but down from 47.0 million in 2006.

• Nearly 37 million were employment-age adults (ages 18 to 64).

• More than 27 million worked at least part-time.

• Nearly 50 percent lived in households with annual incomes of less than $50,000 — 24.5 percent had incomes less than $25,000, and 21.1 percent made $25,000 to $50,000.

• The number of uninsured children declined from 8.7 million (11.7 percent) in 2006 to 8.1 million (11.0 percent) in 2007.

• People of Hispanic origin were most affected. Nearly one-third of Hispanics lacked health insurance.

• The South had the highest uninsured rate, with 18.4 percent. At 11.4 percent each, the Northeast and the Midwest had the lowest. The West had a 16.9 percent uninsured rate.  The rates declined from 2006 in every region except for the Midwest, where the change was not statistically significant.

• Averaged over three years from 2004 to 2006, Texas ranked first in rate of uninsured residents with 24.1. New Mexico was second with 22 percent. Mississippi was sixth, with 18.8 percent. Last on the list — tops for insured individuals — were Hawaii and Massachusetts, tied with 8.3 percent uninsured.

Source: U.S. Census Bureau, 2007

Free or reduced medical care

• Good Shepherd Community Center, 629 Cherry St., offers a free medical clinic for people without medical insurance every Tuesday and Wednesday beginning at 11:30 a.m. Spaces are limited. Services offered include routine medical exams, monitoring and some prescription medications. Phone, 601-636-7687.

• First Baptist Church on Cherry Street offers a free medical and dental clinic the third Thursday of each month at the Mafan Building, 1315 Adams Street. Services are limited to low-income people without medical insurance, and include exams, some lab work, tooth extraction, nutritional and spiritual counseling and some prescription medications. Registration starts at 3 p.m., with separate areas for doctor/dentist visits and prescription refills. Phone, 601-636-2493.

• Tri-County Health Group, 3312 Oak St., phone, 601-629-9500, and Vicksburg Warren Family Health Care, 1203 Mission Park Drive, phone, 601-634-8850, provide comprehensive primary and preventive health care, discount prescriptions and some social services to uninsured and underinsured people, including children. Services are offered on a sliding- fee scale based on income and family size.

*

Their stories

Some of the medically uninsured in Warren County:

•

Lydia Myers, 44, was a factory worker at the Yorozu Automotive Mississippi plant in Flowers for nearly five years. When the plant closed in mid-December for what plant officials called “a temporary work stoppage,” Myers was laid off.

With her job went her health insurance, which ran out Jan. 1.

Myers is able and willing to work, and has been out on interviews since her layoff but has not yet found a job.

With asthma, high blood pressure and, lately, swelling in her leg, Myers was in line earlier this month to see Dr. John Robert Ford at Good Shepherd Community Center medical clinic. She needed a checkup and medications.

Myers had been a regular patient at Good Shepherd before she began work for Yorozu and returned after losing her medical insurance.

Yorozu has not reopened.

•

Gregory Jefferson, 48, drove a truck for seven years for Star Transportation, a Nashville company with 600 tractor-trailers. He got sick in January.

“They thought I had walking pneumonia,” he said. But the doctors discovered a heart problem and performed surgery in March to implant a defibrillator. Now he’s not allowed to drive a truck, as U.S. Department of Transportation regulations prohibit drivers from having implantable defibrillators because the risk that the devices can cause a sudden drop in blood pressure and loss of consciousness.

Jefferson is on short-term disability but his medical insurance plan ended in May.

“They say I can get a job driving a forklift or something,” Jefferson said, but he’s had no success finding another job. Prospective employers don’t want to deal with his medical issues, he said.

Jefferson, waiting to see a doctor at Good Shepherd, also suffers from gout. He was on crutches, his sister helping him navigate the stairs up to the second-floor clinic.

The early-July visit was his second; the first was two weeks earlier, after he’d heard from his sister about being able to get free medical care there.

•

Patricia Rucker, 49, is a California native who has lived in Vicksburg for five years, since she came here to marry a local man.

She works full time as a security guard for Red Carpet Security in Vicksburg, which does not offer insurance to its employees. “They’re a small company,” Rucker said. “They can’t afford it either.”

Rucker has been a patient at Good Shepherd for three or four years, needing treatment and medications for diabetic and heart-related issues. She said if she ever needed surgery for any reason she’d be in big trouble.

“So many people these days, you hear them say they don’t feel good, but they have no health insurance and can’t afford to be hospitalized. What do they do? That’s just the state of things right now. That’s reality.”

She tells others about the Good Shepherd and First Baptist Church clinics.

Rucker’s anticipating changes in her personal life and might move to Jackson, perhaps needing two jobs to make ends meet. She hopes one of them will offer health insurance.

“I come from a family of hard workers — ranchers, farmers, merchants,” Rucker said. “We were raised on the idea that you always help your neighbors.”

Rucker is now among those who need that help.

•

David Arthur, 30, is a self-employed bricklayer. He was waiting at the First Baptist clinic to see a dentist and have abscessed teeth pulled. Arthur had gone to the emergency room for antibiotics and pain medication, then back to the clinic for the extractions.

“There’s nothing but the emergency room,” said Arthur’s mother, Georgenia Arthur, who helps David Arthur take care of his daughter. “There’s no other place to go for medical care.”

First Baptist has three dentists who volunteer their time at the once-a-month clinic, but they have only the facility to pull bad teeth. So far, no preventive dental care or cavity fillings are offered.

•

Mary Braswell, 58, and her husband own a farm of about 45 acres on U.S. 61 North in the Redwood community. Braswell’s husband is 70 and qualifies for Medicare, but she can’t afford insurance and goes to the First Baptist clinic each month for arthritis, high blood pressure and cholesterol medication.

“We don’t make very much off it,” she said of the farm. Spring floods took 10 to 12 acres of their soybean crop, so their profits will be even less this year. “If it weren’t for places like this, a lot of people wouldn’t be able to make it. It’s a godsend.”

Braswell said she’s trying to get her blood pressure and cholesterol under control with good diet and exercise, but can’t always do as much walking as she would like. Her husband suffers from multiple health problems, and often Braswell is tending to him as well as the farm.

“We do what we can,” said Braswell, who drives a tractor and does other farm chores. The couple’s grown children help, as well as hired workers. After paying for seed, chemicals, fuel and insurance on their vehicles and home, there is no money for health insurance.

“It’s getting worse and worse with so many people losing their jobs,” she said. “People have to choose between going to the doctor and paying their bills.”

*

Contact Pamela Hitchins at phitchins@vicksburgpost.com