Community Benefit

The world of health care is under stress and changing. But there’s one area of support that Legacy Health intends to maintain during this period of great flux: our commitment to society’s most vulnerable people. 

A cornerstone of Legacy’s Community Benefit priorities is providing financial support to two programs that aid people on the outer fringes of the healthcare system: Project Access NOW’s (PANOW) payment support program and Health Systems Access to Care Fund. PANOW’s payment support program helps people with the cost of Affordable Care Act premiums, while the Access to Care Fund supports free clinics that serve people who cannot access traditional health care because of their immigration status, lack of insurance or simply because they feel unsafe. 

These programs are well-known staples within a complex health system that is difficult to navigate for everyone — even those with first-rate employer-sponsored insurance coverage. 

Still, seismic federal policy changes — to the Affordable Care Act, Medicaid administrative requirements, and general immigration policy shifts — may leave society’s most vulnerable one step closer to crisis. This scenario is where competing health systems will need to work together more than ever, says Justin Huff, Legacy’s director of Medicaid and community benefit. 

“When there’s an earthquake or tornado or some catastrophic natural disaster that hits our region, the hospitals have infrastructure in place to be able to work together and support each other with resources,” says Justin. “That includes staffing, generators and medical equipment. That is the only setting where I have seen healthcare organizations come together, sit at the same table and work together to solve a problem. Otherwise, we're competitors in most respects. But now, access to health care. That’s a (similar) crisis, too.”

Different local health systems and organizations fund the two programs. For example, Legacy, Providence Health & Services, Kaiser Permanente, Oregon Health & Science University, Adventist Health, and Hillsboro Medical Center collaborate to fund PANOW’s payment support program, while Kaiser, Providence, PeaceHealth and CareOregon contribute to the Access to Care Fund.

For Legacy, contributions to the two organizations have been generous and consistent. Since 2019, Legacy has donated $150,000 annually to the Access to Care Fund. Funds for PANOW’s payment support program started around 2008 — the payment support program began in 2007 — with benefit amounts varying year-to-year, including $249,846 scheduled for 2026. 

The impact of these funds is impossible to measure. But the material effect is meaningful and plain to see, says Jordan Skornik, executive director of Borland Free Clinic, an Access to Care fund recipient. 

Based in Tualatin, the Borland clinic provides over 1,200 patient appointments annually, with 500 unique individuals served. Its patients are a wide swathe of society’s vulnerable: the uninsured, working poor, undocumented individuals, and anyone who needs timely care, regardless of geography. There is no cost or billing for services. The services are crucial, primary ones: Annual exams, chronic disease management, medication refills and on-demand care needs. The clinic also provides vaccinations, lab work, physical therapy, mental health, and women’s gynecological health, among other services. 

Jordan describes clinic patients as those who have fallen through the major gaps of the healthcare system, with the clinic operating as a kind of “safety net of the safety net.” 

“Government programs like Medicare and Medicaid are often described as the ‘safety net,’” says Jordan. “And so, when it comes to organizations like our clinic, we and others like us purport to be the ‘safety net of the safety net.’” 

One patient group, he says, is Medicaid recipients who are in the process of waiting several months to see a primary care doctor but may also need to see a provider well before that time. Jordan says the clinic provides such patients with “bridge visits.” 

Another type of patient is someone whose income is too much to qualify for the Oregon Health Plan but too little to access insurance on the open market because they do not have employer-sponsored health care. 

“These patients are referred to as the ‘working poor,’” Jordan says. “There’s a misperception that our patients are at home and prefer not to work or something. But the fact is they’re hard-working individuals who don’t have employer sponsored benefits and can’t afford it otherwise. So that’s where the gap comes.” 

Jordan says the Borland clinic is run by mostly volunteers. Annually, about 150 volunteer physicians, nurses, interpreters, support staff and board members contribute time. The clinic has just four paid administrative staff. 

Critically, the clinic is entirely dependent on philanthropy to fund its mission. Forty percent of the funding comes from grants; the rest comes from individual donations. There is no fee-for-service revenue, no contracts or insurance billing. There is, however, an annual fundraising gala, and the clinic welcomes individual giving year-round.

Jordan says the different streams of funding, such as Legacy’s contribution, is invaluable but also reliable. 

“It’s (Legacy’s) a pretty significant and regular grant,” he says. “So, we're hoping that continues. But another thing: the grant can be spent on operations, the bread-and-butter work that we do operationally.” This includes overhead, staffing and core services.

Forthcoming federal policy changes will negatively affect those seeking health care as well as the health systems serving them. The loss of ACA subsidies will result in more uninsured people, for instance. New Medicaid requirements will similarly mean greater losses in patient coverage, while undocumented individuals may avoid care entirely. 

Healthcare experts nationwide say these factors will increase uncompensated care across most systems, which will, in turn, increase demands on free clinics who may not be able to fully absorb them.

“There’s just no way that the free clinic can fill that hole,” says Jordan, who also believes federal policy changes will make competition for grants more intense. 

What does the future hold? Jordan says he hopes funding streams for all clinics like Borland remain steady, while funders like Legacy, for its part, remain committed to grants for the Access to Care Fund and PANOW’s payment support program.

Indeed, Justin says that Legacy remains fully committed to both programs for the near future. Diana Netter, a community benefit program specialist and Justin’s colleague, says the collective commitment by different local health systems signals how deeply they recognize the importance of both programs, and that more support is to come.

“I think both of these programs having community partners is kind of unique,” she says. “That highlights the importance of the work being done, and the fact that we've all come together shows how big an issue this is. We're always looking for ways to grow this (collaboration) and we’re hoping to grow it in the future. It's been a great start.”