According to census data, over 50 million Americans were insured in 2009. When fully implemented in 2014, that number is supposed to shrink by 32 million. That leaves 18 million people in this country still without healthcare coverage. One safety net is the national network of free clinics. It provides free primary care services without tax dollars, and has been in use since the 1960s. Free clinics are small, volunteer-staffed medical offices which have adapted to the changing needs of the country for the last 50 years. They provide healthcare services to consumers who have often fallen through the cracks. In spite of the increase in covered Americans once the Affordable Care Act goes into full effect, the need for free clinics is still anticipated.
Currently free clinics provide medical and limited dental services to Americans without health insurance or the ability to pay for healthcare. They specialize in treating chronic conditions, such as hypertension, asthma and diabetes, and feel that their role in community health is to keep people from using the Emergency Department to manage their health. They offer free primary care and some specialty care, diagnostic testing, medication assistance programs, and some offer extra services such as free laundry, a food pantry, prepared meals and infant supplier (e.g. formula and diapers).
Looking ahead, the Free Clinics of Michigan (FCOMI.org) network relies on the generosity of donors and volunteers to provide services in the community. Therefore, they are planning to adapt their services to meet the needs under Obamacare. When looking at states that were already granted federal waivers to expand Medicaid to their uninsured populations, they noticed that the number of free clinics grew, not shrank, once more citizens of those states were covered under insurance. One reason for this is because they offered navigation services to help their patients enroll in Medicaid. They also cared for patients who gained and lost their Medicaid coverage due to seasonal employment. Additionally, they addressed big gaps in coverage such as dental care and prescription assistance. Due to the shortage of primary care doctors overall (who accept Medicaid), free clinics continued to see patients with insurance but did not bill for services.
Although the ACA will expand coverage to millions of uninsured Americans, the law is not intended to cover everyone during its initial phase. According to FCOMI.org, who will remain uninsured?
- People below 100% FPL (or about $11,500), who are not eligible for federal subsidies to buy insurance, nor are they eligible for Medicaid in the state where they reside
- Undocumented immigrants
- Naturalized citizens in the country < 5 yrs.
- Those who choose to pay the penalty rather than acquire insurance
- Those who are exempt from the mandate and choose to remain uninsured, e.g., veterans, those exempt from filing a federal tax return, Native Americans, incarcerated citizens, and those who refuse based on religious conscience.
One thing that free clinics know: if Obamacare is a smash hit and continues to reduce the number of uninsured Americans, they will still need to remain in place to transition patients to the new healthcare system. Counselors can help patients find insurance on the federal marketplace, or apply for Medicaid. After that, they will need to help patients find a new medical home and aid in transitioning care to the new provider.
Get to know the free clinics in your community and consider volunteering your services! The video is an introduction to the Hope Clinic, a free clinic based in Washtenaw County, and a satellite clinic in western Wayne County. Together, they provide more than 7,000 office visits annually and process more than $2.5M in prescription medication applications for its clients.
Excellent work, Danielle. You note that there will always be a place for free clinics, and you are entirely accurate. Even with the healthcare changes rapidly approaching, healthcare will still be a crippling cost for many Americans. Many major-medical and many basic plans are disappearing as options for Americans, who will be left with plans that contain a ridiculously high deductable they simply cannot afford. Free clinics will still have their place for these people who need quick assistance and cannot afford to go to the emergency department or walk-in clinics.
ReplyDeleteDanielle, This was a great piece. It's so important to consider the impact of the national directives on these important contributors in our society. In Lansing, I worked with a doctor who founded two free clinics (Dr. Barry Saltman, Carefree Medical) - one in Lansing and one in Mason. It was huge in the community when he incorporated the dental piece. Dental services are not covered in so many cases - especially those unfortunate enough to qualify for Medicaid. Before Carefee, the uninsured in Lansing had to travel to Grand Rapids IF they were lucky enough to get an appointment before their dental issues landed them in a local emergency room. As we heard from our guest speaker this week, a good portion of ER cases are dental emergencies. I loved the comment about how they are not just providing dental service, but giving people their lives back by way of employability, self-respect, dignity and confidence. So true, and something most of us take for granted.
ReplyDeleteGreat post Danielle, I am currently working with the Student Run Free Clinic in Pickney as they try to provide services to many of the uninsured in Livingston County. I would suggest that even if every healthcare worker only gave one day per month at a free clinic that it would make a tremendous difference in population outcomes. Free Clinics with qualified health professionals allow for a open conversation about lifestyle and patient health. It would appear that the majority of health problems in the US come from preventable conditions. Therefore, education of community members is a more effective prescription when compared to complicated procedures or medication. Ideally, the hospital setting should only have to be used for non-preventable conditions, emergencies, and trauma.
ReplyDeleteDanielle,
ReplyDeleteThanks for writing this. I had not considered how the ACA would impact free clinics. Furthermore, I haven't seen the list of who will still not be covered with the ACA. I hope the clinics are not forgotten about because I would hate to see the services offered by free clinics to go away.
Danielle, this was a good post. Healthcare is in a difficult transition right now and it is difficult to treat all the patients that require attention. Free clinics are a good opportunity for people to go and get everyday check ups and prescriptions filled without worrying about the cost of receiving such simple care. Most of the issues in the United States could decrease by simple preventative measures which free clinics could do. It is crazy to think that 18 million people in the United States will still be without insurance once this is all said and done in 2014. I did not realize that they estimated 32 million people to become insured through Obamacare. Free clinics can open up the emergency rooms for more immediate care patients.Emergency room visits are extremely pricey as is.
ReplyDeleteDanielle, Your post brought up a topic that is not discussed often enough. Thank you for putting forward and issue that we as nurses could help with. I am looking for a volunteer opportunity in my neighborhood and a free clinic sounds ideal. You mentioned some chronic illnesses in which they specialize in treating, such as hypertension and diabetes. Treating these silent killers among poor populations has got to be a way to make a real impact.
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