Kaiser Health News published an excellent column detailing the impacts of Obamacare on the nation's existing 1,200 free, charity-based and locally-funded free health clinics. The entire piece is well worth your time to read but I've provided an excerpt below to illuminate what I find to be the most troubling impact.
Federal governmental intervention and bureaucratic-overlay is now thrust into the forefront to address what used to be resolved locally and charitably. At best, federalization crowds out a charitable, personal, solution. At worst it eviscerates it for the 6 million Americans who are regularly treated at such clinics.
WHEELING, W.Va. - Without insurance, Pam Milliken relied for years on the free health clinic here to help manage her arthritis, high blood pressure and diabetes. When she needed to have her gallbladder removed, the clinic, located in a former State Farm Insurance building, found her a specialist and hospital willing to do the surgery at no cost.
This year, Milliken was among the 70 percent of patients at Wheeling Health Right Center who enrolled in Medicaid after the state expanded the program under the Affordable Care Act.
David Markson is getting treated by Thelma Fitzgerald, a nurse practitioner, at the Eastern Panhandle CARE Clinic in Ranson, W.Va. He now is on Medicaid but still goes to the clinic along with his wife, Melinda.
Worried that patients like Milliken would leave their care and struggle to find doctors accepting new Medicaid patients, the clinic took a rather radical step: It became a Medicaid provider and started billing the state-federal health insurance program for the poor.
On a recent weekday, Milliken, 55, who makes salads at a local truck stop restaurant, was getting a checkup and X-rays at the clinic, which now requires a $2 Medicaid co-pay. "I've been with these people for years and they know me better than anyone," Milliken said, explaining why she chose to keep coming to the clinic.
In fact, eight of the nine non-profit free clinics in West Virginia this year began participating in Medicaid. The shift - which also occurred to a lesser degree in Ohio and Illinois, among other states - is being closely watched nationwide and reflects how facilities are adapting in the 26 states that expanded Medicaid....
... A Tremendous Upheaval
The nation's loosely organized network of free clinics have come a long way since the 1970s when most were made up of volunteer doctors and nurses working a day or two a week in church basements. Today, about 1,200 free clinics serve about 6 million patients, according to the National Association of Free and Charitable Clinics. Their increasingly modern facilities look much like private medical offices that serve patients with insurance. They often use electronic medical records, pay administrative staffs and nurse practitioners, and run their own pharmacies.
Unlike the nation's community health centers, which receive billions in federal funding and are a key part of the health law's push to expand access to health care, free clinics have traditionally relied on private donations, and state and local assistance. Community health centers, which also treat poor patients, charge patients above the poverty level on a sliding fee scale and are paid a higher Medicaid fee than private physicians.
Obamacare has clinics worried the public will think they are no longer needed even though millions of people remain uninsured, particularly in states not expanding Medicaid, said Nicole Lamoureux, executive director of the National Association of Free and Charitable Clinics. It's "a very large misconception ... that everyone will have insurance or access to health care," she said. Under the health law, states have the option of expanding Medicaid to cover everyone with incomes below 138% of the federal poverty level, or $15,856 for an individual....
At Milan Puskar Health Right in downtown Morgantown, W.Va., - the only free clinic in the state that has not started taking Medicaid patients - the number of patients has dropped from about 1,700 a year ago to fewer than 500 today....
Home to the University of West Virginia Medical School, Morgantown has no shortage of doctors accepting Medicaid patients. "We did not want to compete for Medicaid patients with the same doctors who volunteer for us," said Laura Jones, the clinic's executive director, explaining why it did not participate in the program....
But participating in Medicaid comes with strings attached. For example, the clinics have to get state approval before referring patients for surgery or expensive diagnostic tests like CT scans and MRIs. Some patients have also had to switch drugs because Medicaid only covers certain generics and brand medicines. And patients now must pay small co-payments, typically $2, for an office visit, compared to zero before.
It also comes with challenges. Shifting from a free clinic to one that gets paid could hurt donations and alienate volunteer doctors, Echo's Hiller said. Also, the federal government and some states provide liability protection to doctors at free clinics, which could be threatened if the clinics get paid, he said....
Source: KHN & USA Today, Obamacare Creates 'Upheaval' At Free Clinics.
