Some free health clinics serving the uninsured are shutting
their doors because of funding shortfalls and low demand they attribute to the
Affordable Care Act’s insurance expansion. Nearly a dozen clinics that have
closed in the past two years cited the federal health law as a major reason.
The closings have occurred largely in 28 states and
Washington, D.C., which all expanded Medicaid, the federal-state insurance
program for low-income people, and are being heralded by some clinic officials
as a sign the health law is reducing the number of uninsured. But the closures
have irked some patients and left pockets of uninsured people not covered by
the law with fewer venues for care. Some of the roughly 1,200 U.S. free and
charity clinics are struggling with a drop in funding because donors believe
there is no longer a need for free or low-cost care in the wake of the health
law. That is making it particularly difficult for clinics that still report
strong demand, especially in states that didn’t expand Medicaid.
Over the past two years, donations to free and charity
clinics, which in some cases charge nominal or sliding fees, have dropped 20%,
according to a report this year by the National Association of Free and
Charitable Clinics. During that time, patient demand has risen 40%. While some
clinics are closing, others are reinventing themselves. Some are accepting
Medicaid while also offering free services. Others are launching dental care or
mental-health services to augment their offerings.
Free and charity-based clinics see about 5.5 million visits
annually, and less than half have an operating budget under $100,000. The 2010
health law set aside $11 billion to fund community health centers, a designation
that applies to clinics that meet certain requirements such as charging
sliding-fee scales and having a board of directors. Many clinics that serve the
poor don’t get that funding and rely instead on donations and grants to provide
medical, dental, pharmacy, vision and behavioral-health services.
The Western Stark Free Clinic in Massillon, Ohio, was
scheduled to close this month. The 15-year-old clinic experienced a 30% drop in
patients since the beginning of the year because many are now eligible for
Medicaid. The Good Samaritan Free Clinic in Rock Island, Ill., opened about
seven years ago and provided primary care for the uninsured for no cost. The
clinic closed in the spring because its directors felt there was no longer a
need following the rollout of the health law.
The health law also led to the closure in February of the
No-Fee Chronic Disease Medical Clinic in Olympia, Wash. The volunteer clinic
provided care to about 650 people with illnesses such as diabetes, asthma and
hypertension and who had no medical insurance. It saw many patients move to
Medicaid when the program expanded this year.
More than one million Washington residents enrolled in
health plans through the state’s exchange, dropping the state’s uninsured rate
by 30%, according to the Washington Health Benefit Exchange. The health law
will reduce the number of uninsured by 25 million by 2023, according to a May
2013 report by the Congressional Budget Office. That will still leave 31
million Americans without health insurance.
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