Ithaca Health Alliance
Encyclopedia
The Ithaca Health Alliance is a community-based health care
cooperative
based in Ithaca, New York
. It incorporates financial and service assistance models to alleviate health care costs for its members and is a model for cooperative health care reform in the United States
. The mission of IHA is to facilitate access to health care for all, with a focus on the needs of the un- and underinsured. IHA sponsors and operates the Ithaca Free Clinic.
organized by local innovator Paul Glover
, began working with their community to address the issue of access to health care. Inspired by the examples of the Canadian national health care
system as well as the collective approach to health care financing among the Amish
, an idea dubbed the "Ithaca Health Fund" was born. The original vision of this health cooperative included:
The new organization soon attracted members, each joining for $100 per year. As more people joined what became known as the Ithaca Health Alliance (IHA), the organization's finances improved, and a better selection of health care services became available. At the same time, members began setting aside money for other community health
projects. Glover was the Fund's first administrator and the only paid IHA staffer. He kept costs down by drawing a modest salary, while the structure of the Fund itself helped to encourage prevention and therefore manage costs in a realistic manner. One early Fund example was a dental category with a $20 contribution to the annual cost of an exam and cleaning. Over time, the scope of care covered by the Fund expanded to include stitches, the treatment of broken bones and emergency room care.
By 2004, the Ithaca Health Fund was a well-known local alternative to health insurance. Members primarily resided in Ithaca and Tompkins County
, but the Fund had fairly wide representation across the state of New York. Glover continued to serve as the Fund's administrator, and his informal style of record keeping and Fund management earned him points among the members, who appreciated the lack of red tape. Membership was affordable, services were limited but basic, and the Fund remained solvent.
In a bid to grow the Fund beyond its New York membership, Glover began marketing it to other states. At the same time, a journalist at the Utne Reader
learned about IHA and began researching an article. A reporter for a health insurance blog interviewed Glover, then contacted the New York State Insurance Department
(NYSID), which immediately began an investigation. NYSID claimed that IHA had been selling insurance
without a license. After months of wrangling, IHA's lawyers reached an accord via the NYS Attorney General's office, promising to replace terms like "benefits" with "grants" and assuring NYSID officials that IHA would discontinue offering memberships beyond New York's borders.
Eventually NYSID relented, recognizing that Glover's enthusiasm for the mission of "health care for all" was well-intentioned. Today the IHA and its programs continue to operate with the same core mission and principles of its founders.
In the beginning, members were active in IHA matters, wanting input into decisions and consistently willing to spend long hours at organizational meetings to hammer out policy and set IHA's direction. Today, however, members expect the Board of Directors to take responsibility for the organization. For example, the Board oversees the staff, operational details of all its programs, and every leadership-level decision within IHA.
Since the NYSID decision, IHA program development has exceeded local expectations. To date, the Fund program has awarded more than $200,000 in grants. IHA members can apply for grants of up to $3,000 to $4,500 per year for specific healthcare needs. Most frequently requested grants are for dental care, whereas the biggest grant categories are dedicated to emergency services. The IHA seeks to expand grant categories annually, based on the needs expressed by members and the resources of the organization. In addition to the services available through grants, a revolving loan fund provides interest-free help to members for dental and eye care.
s, and many others. Most providers live and work in Ithaca and the surrounding villages and towns of Tompkins County. IHA maintains a provider member directory on its website, thus promoting providers' commitment to community health.
s that conduct health projects. A few examples include funds for the Cayuga Nature Center (CNC), which received grants to train its Bobcat camp counselors in CPR
and resources to buy medical supplies and protective gear for CNC staff. IHA has also used Community Grants to subsidize shares in a Cornell Cooperative Extension program that makes food from the area's community-supported agriculture
program available to low-income families. Recently under the grants program IHA and other health education agencies joined with a local environmental group, Sustainable Tompkins, for presentations centered on "Sustainable Health Care for All."
Conventional medical care accounts for 70 percent of services the Free Clinic provides. Most days, alternative practitioners, such as herbalists, massage therapists, chiropractors, and acupuncturists, join physicians and registered nurses. Nutritionists offer scheduled appointments for education and consultation, and a newly developed occupational therapy program provides case management and therapy for a range of human conditions.
An estimated 12,000 residents of Tompkins County have no health insurance. Without IFC, many of these people could also expect to be without medical care. Unable to pay out-of-pocket fees for service, the uninsured residents in and around Ithaca are frequently dangerously ill before they learn about IFC. Three years of providing care to indigent and working poor populations has revealed to staff and volunteers that IFC is the primary source of care for most of the Clinic's patients.
but has so far met with one impediment after another. IRS officials have been particularly confused about the Health Fund and related member services, failing to understand that although IHA is a member organization, many memberships and much of the organization's work relies on charitable contributions and donated services.
Without individual contributions of money and large grants for projects and operating costs, the Free Clinic is in jeopardy. Contributors and funders other than IHA members often see tax exempt status as both the highest form of institutional respectability and the best way of getting credit for having made a financial donation. IHA members, on the other hand, provided IFC's seed money, but members typically earn just 30 to 50 percent of the average median income for the area and cannot afford ongoing financial support of the Free Clinic, whether or not their contributions are tax exempt.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
cooperative
Cooperative
A cooperative is a business organization owned and operated by a group of individuals for their mutual benefit...
based in Ithaca, New York
Ithaca, New York
The city of Ithaca, is a city in upstate New York and the county seat of Tompkins County, as well as the largest community in the Ithaca-Tompkins County metropolitan area...
. It incorporates financial and service assistance models to alleviate health care costs for its members and is a model for cooperative health care reform in the United States
Health care reform in the United States
Health care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
. The mission of IHA is to facilitate access to health care for all, with a focus on the needs of the un- and underinsured. IHA sponsors and operates the Ithaca Free Clinic.
History
In 1997, grass roots activists in Ithaca, New YorkIthaca, New York
The city of Ithaca, is a city in upstate New York and the county seat of Tompkins County, as well as the largest community in the Ithaca-Tompkins County metropolitan area...
organized by local innovator Paul Glover
Paul Glover
Paul Glover is a community organizer currently based in Philadelphia, Pennsylvania. He has been adjunct faculty at Temple University and founder of the Philly Orchard Project and editor of Green Jobs Philly News....
, began working with their community to address the issue of access to health care. Inspired by the examples of the Canadian national health care
Health care in Canada
Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards...
system as well as the collective approach to health care financing among the Amish
Amish
The Amish , sometimes referred to as Amish Mennonites, are a group of Christian church fellowships that form a subgroup of the Mennonite churches...
, an idea dubbed the "Ithaca Health Fund" was born. The original vision of this health cooperative included:
- Focus on the local community for solutions, rather than relying on the benevolence of employers, corporations, or the government.
- Use a democratic infrastructure, centered on the thoughts and identified needs of members.
- Offer a sliding scale fee to health care providers who gave discounts to other Health Fund members.
- Set aside savings for a clinic and other community health programs.
The new organization soon attracted members, each joining for $100 per year. As more people joined what became known as the Ithaca Health Alliance (IHA), the organization's finances improved, and a better selection of health care services became available. At the same time, members began setting aside money for other community health
Community health
Community health, a field of public health, is a discipline that concerns itself with the study and betterment of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared...
projects. Glover was the Fund's first administrator and the only paid IHA staffer. He kept costs down by drawing a modest salary, while the structure of the Fund itself helped to encourage prevention and therefore manage costs in a realistic manner. One early Fund example was a dental category with a $20 contribution to the annual cost of an exam and cleaning. Over time, the scope of care covered by the Fund expanded to include stitches, the treatment of broken bones and emergency room care.
By 2004, the Ithaca Health Fund was a well-known local alternative to health insurance. Members primarily resided in Ithaca and Tompkins County
Tompkins County, New York
Tompkins County is a county located in the U.S. state of New York, and comprises the whole of the Ithaca metropolitan area. As of the 2010 census, the population was 101,564. The county seat is Ithaca, and the county is home to Cornell University, Ithaca College and Tompkins Cortland Community...
, but the Fund had fairly wide representation across the state of New York. Glover continued to serve as the Fund's administrator, and his informal style of record keeping and Fund management earned him points among the members, who appreciated the lack of red tape. Membership was affordable, services were limited but basic, and the Fund remained solvent.
In a bid to grow the Fund beyond its New York membership, Glover began marketing it to other states. At the same time, a journalist at the Utne Reader
Utne Reader
Utne Reader is an American bimonthly magazine. The magazine collects and reprints articles on politics, culture, and the environment from generally alternative media sources, including journals, newsletters, weeklies, zines, music and DVDs...
learned about IHA and began researching an article. A reporter for a health insurance blog interviewed Glover, then contacted the New York State Insurance Department
New York State Insurance Department
The New York State Insurance Department is the State regulating agency responsible for supervising and regulating all insurance business in New York State. It is regarded in the industry as one of the most state-of-the-art insurance regulating agencies. The Superintendent is James J...
(NYSID), which immediately began an investigation. NYSID claimed that IHA had been selling insurance
Insurance
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
without a license. After months of wrangling, IHA's lawyers reached an accord via the NYS Attorney General's office, promising to replace terms like "benefits" with "grants" and assuring NYSID officials that IHA would discontinue offering memberships beyond New York's borders.
Eventually NYSID relented, recognizing that Glover's enthusiasm for the mission of "health care for all" was well-intentioned. Today the IHA and its programs continue to operate with the same core mission and principles of its founders.
The IHA today
At the time of the NYSID decision, IHA membership had risen to 1000. The number of members has now stabilized at about 700 people. Consistent with IHA's bylaws, members elect the Board of Directors from among the membership, and the members, by way of member committees and along with the Board, jointly govern the IHA through shared and ongoing input.In the beginning, members were active in IHA matters, wanting input into decisions and consistently willing to spend long hours at organizational meetings to hammer out policy and set IHA's direction. Today, however, members expect the Board of Directors to take responsibility for the organization. For example, the Board oversees the staff, operational details of all its programs, and every leadership-level decision within IHA.
Since the NYSID decision, IHA program development has exceeded local expectations. To date, the Fund program has awarded more than $200,000 in grants. IHA members can apply for grants of up to $3,000 to $4,500 per year for specific healthcare needs. Most frequently requested grants are for dental care, whereas the biggest grant categories are dedicated to emergency services. The IHA seeks to expand grant categories annually, based on the needs expressed by members and the resources of the organization. In addition to the services available through grants, a revolving loan fund provides interest-free help to members for dental and eye care.
IHA healthcare providers
Over 150 healthcare providers are IHA members, and they give discounts typically from 5 to 10 percent of the cost of their services to other IHA members. Providers include professionals from conventional and complementary/alternative practices, including physicians, dentists, chiropractors, herbalists, acupuncturists, registered nurses, psychologists, doulaDoula
A Doula is someone who provides non-medical support to women and their families during labour and childbirth, and also the postpartum period. The term can also be used to describe other supportive roles for other life events such as abortion, death and more....
s, and many others. Most providers live and work in Ithaca and the surrounding villages and towns of Tompkins County. IHA maintains a provider member directory on its website, thus promoting providers' commitment to community health.
IHA memberships
In addition to the individual membership, which continues to cost the original $100 per year, discounted memberships are available to spouses, partners, and children. Employers also get a 20 percent discounted rate for employees when the employees join as a group. Memberships are frequently made available through the generosity of community donors in IHA's donated membership program, and the Board has committed to paying for additional memberships whenever community or donated funds for the program have been exhausted.IHA Community Grants
The IHA Community Grants program offers small grants to community organizationCommunity organization
Community organizations are civil society non-profits that operate within a single local community. They are essentially a subset of the wider group of nonprofits. Like other nonprofits they are often run on a voluntary basis and are self funded...
s that conduct health projects. A few examples include funds for the Cayuga Nature Center (CNC), which received grants to train its Bobcat camp counselors in CPR
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
and resources to buy medical supplies and protective gear for CNC staff. IHA has also used Community Grants to subsidize shares in a Cornell Cooperative Extension program that makes food from the area's community-supported agriculture
Community-supported agriculture
Community-supported agriculture, a form of an alternative food network, is a socio-economic model of agriculture and food distribution. A CSA consists of a community of individuals who pledge support to a farming operation where the growers and consumers share the risks and benefits of food...
program available to low-income families. Recently under the grants program IHA and other health education agencies joined with a local environmental group, Sustainable Tompkins, for presentations centered on "Sustainable Health Care for All."
IHA educational programs
The Ithaca Health Alliance education program receives high marks from the community. This program has sponsored events at intervals during the past several years, making them open to everyone, and three years ago also undertook the publication of a quarterly newsletter. The newsletter is either mailed or emailed to members. In an effort to fulfill its commitment of education of the community at large, IHA distributes without charge copies of the newsletter to local coffee shops and other public places. As part of this program, IHA has funded the acquisition of books focused on health promotion by the Tompkins County Public Library and the Durland Alternatives Library at Cornell.IHA staff
A combination of resources between the IHA and funders has made it possible to employ three staff members, who receive a modest but certified "living wage" and IHA membership as a benefit of employment. The office manager is responsible for the distribution of grants, communication with members, area officials, and business people. The outreach coordinator works to educate the community about the IHA and the Free Clinic, with a mandate to assess the needs of the community regarding health programs. The clinic coordinator facilitates care during Ithaca Free Clinic sessions, and trains and coordinates volunteers.The Ithaca Free Clinic
With the opening of the Ithaca Free Clinic (IFC) in January, 2006, the IHA fulfilled one of its earliest dreams by making free care available to uninsured residents. In doing so, Ithaca has joined the ranks of generally much larger cities in the U.S. Financed through membership savings from 1997 to the Free Clinic's inception, members continue to support the IFC, as do donations from the wider community. The IHA has also received competitive grants that have allowed for better-supported and expanded Free Clinic services.Clinic hours of operation
The Clinic is open from 2 p.m. to 6 p.m. on Mondays and from 4 p.m. to 8 p.m. on Thursdays, with an appointment day for special services on Tuesdays from 4 p.m. to 7 p.m.Clinic services
IFC is one of only three medically integrated free clinics in the U.S., meaning that visitors are treated by both conventional and complementary healthcare professionals. A physician and a registered nurse are always on duty.Conventional medical care accounts for 70 percent of services the Free Clinic provides. Most days, alternative practitioners, such as herbalists, massage therapists, chiropractors, and acupuncturists, join physicians and registered nurses. Nutritionists offer scheduled appointments for education and consultation, and a newly developed occupational therapy program provides case management and therapy for a range of human conditions.
Clinic volunteers
A large group of support personnel manages the office, advising patients and visitors about community resources and advocating for patients' needs. Upwards of 75 volunteers, including students from area colleges and universities, along with many interested and dedicated community members, freely contribute their time to the ongoing success of IFC.Statistics
In its first year of operation, the Free Clinic completed more than 850 patient visits, nearly triple the number initially anticipated. In its second year, the Clinic had 1880 visits, while in 2008 2091 visits were made to IFC. According to data for the first half of 2009, 70 volunteers contributed 1735 hours of service, for a total of 1121 patient visits. IFC is nearly always busy.An estimated 12,000 residents of Tompkins County have no health insurance. Without IFC, many of these people could also expect to be without medical care. Unable to pay out-of-pocket fees for service, the uninsured residents in and around Ithaca are frequently dangerously ill before they learn about IFC. Three years of providing care to indigent and working poor populations has revealed to staff and volunteers that IFC is the primary source of care for most of the Clinic's patients.
Challenges
The biggest threat to IFC, indeed to the entire Ithaca Health Alliance, is the lack of tax-exempt status. In 2004, IHA began making application for status to the Internal Revenue ServiceInternal Revenue Service
The Internal Revenue Service is the revenue service of the United States federal government. The agency is a bureau of the Department of the Treasury, and is under the immediate direction of the Commissioner of Internal Revenue...
but has so far met with one impediment after another. IRS officials have been particularly confused about the Health Fund and related member services, failing to understand that although IHA is a member organization, many memberships and much of the organization's work relies on charitable contributions and donated services.
Without individual contributions of money and large grants for projects and operating costs, the Free Clinic is in jeopardy. Contributors and funders other than IHA members often see tax exempt status as both the highest form of institutional respectability and the best way of getting credit for having made a financial donation. IHA members, on the other hand, provided IFC's seed money, but members typically earn just 30 to 50 percent of the average median income for the area and cannot afford ongoing financial support of the Free Clinic, whether or not their contributions are tax exempt.