Obamacare Threatens Free Clinics
Obamacare’s most significant effect is an expansion in the number of people dependent on Medicaid, the joint state-federal welfare program for low-income people. Kaiser Health News points out that this is threatening the existence of free clinics. Some are signing up for Medicaid, while others are closing:
“We used to say…’wouldn’t it be great if we no longer had uninsured and we could close our doors and go out of business,'” said Michelle Goldman, CEO at the Eastern Panhandle Care Clinic in Ranson, W.Va., which is one of the free clinics now also taking Medicaid. “But the truth is we like the work we do and enjoy helping this population and believe we still have a lot to offer them.”
While a few free health clinics have shut their doors in Arkansas and Washington, most expansion-state non-profit free clinics are reassessing their business strategies. Medicaid offers the potential to give their patients better access to specialists, diagnostic testing and hospital care, and that’s created a sense of unease for operators of the clinics that for decades have played a key role in the nation’s health-care safety net.
“These changes have caused some real disruption in the free clinic sector trying to anticipate what it means for patients who continue to need our services, and how we can sustain ourselves,” said Marty Hiller, senior consultant with Echo, a consulting firm that works with free clinics. “It’s been 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.
The assertion that Medicaid dependency increases patients’ access appears unfounded: Medicaid patients have terrible access to physicians. It does not appear that access to care has changed for these patients — at least in the short term. However, the change in cash flow mean that the clinics are now more accountable to the federal government than private donors and local government. That will likely increase the bureaucratic burden and decrease quality of care in the long term.
One problem is to get federal money, community health centers have to offer more services than many clinics can afford to provide. I have talked to officials who want to provide services but found the barriers to daunting.
More perverse incentives. The sad part is, we will still probably be needing these clinics due to continued poor access. Docs are fighting to renew the Medicaid pay increases promised by the administration to make it more worthwhile to accept Medicaid.
That’s a big issue. For many doctors, it doesn’t make financial sense to accept Medicaid. Access to medical care is still being limited.
“That will likely increase the bureaucratic burden and decrease quality of care in the long term.”
This is what you get when the country signed on to Obamacare. However, since access to care will still be paltry with expanded Medicaid and Obamacare plans, these free clinics will be of use.
“We used to say…’wouldn’t it be great if we no longer had uninsured and we could close our doors and go out of business,’”
I am sure she meant this in the sense that everyone would have proper access to health care. But for it to come to a reality through the means of Obamacare, I am sure she is regretting it.
Although many such providers claim to look forward to the day when they will be put out of business, when the day comes it is human nature to seek to preserve position and status quo, as best as one can.
Causing free clinics to become more accountable to the government will only hinder their ability to provide the best care they can. While free clinics aren’t exactly the prototype of quality health care, more bureaucratic influence isn’t helping anyone.
It’s going to be interesting to see how Medicaid expansion plays out.