OPINION: Wellness = Health + Financial Literacy

by Dr. Daniel Low

"I've never had a doctor ask," he quipped. "Well, taxes are important, Mr. Jones," I chuckled. Like many others, Mr. Jones had recently summoned the courage to come to his first clinic visit in nearly two years, previously avoiding the medical establishment as COVID-19 raged across the country. With so much time between our last visits, he was expecting questions about his diabetes management and colon cancer screening (which we covered), but whether he needed help filing taxes? That was not what he was expecting.

Yet, as COVID-19 spurs us to reimagine what health care could look like, we need to start envisioning health centers as more than just places to treat disease; we need our health centers to promote wellness, and that means helping secure financial wellness too.

As a Family Medicine physician working with predominantly low-income communities, I see my patients suffering from inflation and the economic impact of COVID-19. Health is intricately linked to wealth, and patients cannot effectively care for themselves when they are struggling to pay rent and buy groceries. To keep my patients healthy, I need to help them achieve economic stability. And that starts with taxes. Virtually every working individual on Medicaid — most of my patients — qualify for the federal Earned Income Tax Credit (EITC), where they can receive hundreds or thousands of dollars in tax credits. The EITC program is the largest and most effective anti-poverty program in the country. Yet, over 20% of people who qualify for the EITC never claim it because of the difficulty of navigating our complex tax system. In Washington State, the numbers are even more sobering; more than 25% of estimated beneficiaries do not claim their tax benefits.

As such, I have started asking my patients if they need help filing taxes, and if so, directing them to organizations like United Way and the AARP Foundation, whose certified Tax-Aide volunteers help those in need file taxes for free. But most people are unaware of the services offered by these organizations, and many others are unaware that they are eligible to access them. Others are understandably hesitant to divulge their financial information to strangers. Addressing this chasm of trust and information requires longitudinal, caring relationships. These types of personal and communal relationships are the foundation of community health centers (CHCs), and uniting medical and financial institutions may provide an innovative way to bridge the gap and promote economic and medical well-being.

Medical-financial partnerships can leverage the positionality and expertise of cross-sector organizations to reduce the number of tax beneficiaries not claiming their rebates. CHCs have trusted, intergenerational relationships with low-income individuals, families, and communities across the country, and could serve as screening catchments for those needing tax assistance. These clinics could then serve as conduits to financial experts who could assist patients in accessing tax rebates. Such collaborations have emerged in recent years with remarkable success. In Boston, primary care clinics associated with StreetCred have helped 750 families receive $1.6 million by providing free tax assistance in their clinics. With a similar model, DotHouse Health in Dorchester, Massachusetts, has helped over 1,000 low-income patients accurately file taxes, resulting in an average of over $2,000 in refunds per participant. Similar results have been observed in San Francisco, where San Francisco General Hospital and its affiliate clinics recently launched a financial fitness program to help patients freely file taxes.

CHCs are the bedrock of health care for our low-income communities. It is time CHCs are supported to serve as more than just institutions that provide health care, but also as institutions that promote health. This means financially investing in CHCs to allow holistic, wrap-around care, including financial services. In turn, CHCs need to think bigger and broader, being open to engaging with social entrepreneurs and partnering with cross-sector leaders. With tax season ending, this upcoming year serves as an opportunity, and a beckoning, for our medical and financial leaders to collaborate to reduce poverty and enhance health for people like Mr. Jones. That starts with partnering to implement free tax preparation.

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Dr. Daniel Low is a Family Medicine physician at HealthPoint in Renton. He serves as the vice president of King County Medical Society, and is an active member of the Economic Inequity Task Force of Washington Physicians for Social Responsibility.

Featured Image: Photo by Andy Dean Photography/Shutterstock.com