Free clinics are wary of how health reform will affect them

By Melissa Patrick
Kentucky Health News

Free health clinics for the uninsured face an uncertain future as the Patient Protection and Affordable Health Care Act is implemented. Kentucky has more than 50 such clinics.

The Anderson County Community Medical Clinic, which just celebrated its one-year anniversary this month, serves uninsured people in its community and faces a "threat with the power to close its doors for good: Obamacare,"  Meaghan Downs of The Anderson News reports. Still, several board members told Downs that they do not expect to have to "shut down anytime soon" because some people will remain uninsured even though the health-reform law requires all Americans to sign up for health insurance or face a penalty.

?As long as the people qualify as living in Anderson County and having no insurance, we?re going to serve them,? Opal Phillips, the non-profit clinic's board chairman, told Downs. ?If we are at the end of our usefulness, we will be there until we are no longer needed.?

Since it opened, the clinic has seen about 175 uninsured patients with chronic illness, Phillips told Downs. Lately, he said, the clinic has encouraged patients to sign up for coverage through the state's health-insurance exchange, Kynect.

The state says Kentucky has more that 640,000 uninsured citizens, or 15 percent of its population, and 308,000 will qualify for the expanded Medicaid program, but only about two-thirds of those people are expected to sign up.

Funding is another concern for free clinics under the reform law. Jane Bennett, the Anderson County clinic board's secretary for the last three years, told Downs that she is "extremely concerned about the health-care law and how that will affect fundraising for the clinic in the new year."  After the initial start-up funding from donations, the clinic must continue to find ways to pay for all of its services.

Bennett also told Downs that board members at the clinic may need to change the way it does business by changing the requirements on the types of patients they see. She went on to tell Downs that the uncertainty of how many will be uninsured after the exchange closes and taking into consideration the "blips" that occurred in the roll-out, the implementation of the law will take time.

Laura Ebert, president of the Kentucky Free Health Clinic Association, told Downs that she estimates it will be "at least two years before clinics like Anderson's will see any impact from Obamacare."  Many lower-income people, she said, "may not even take the first step to sign up for exchanges because of a lack of access to technology or education about the new health care law. There will still be a great need for clinics like hers and Anderson County?s."  She said "22 million Americans will still be uninsured even after every element of the federal and state exchanges are put into place," Downs reports.
Ebert is also the executive director of Surgery on Sunday, a clinic in Lexington that performs free outpatient surgeries for free to income-eligible individuals and their families. She told Downs that future considerations for this clinic and the other 54 free clinics across the state will be whether they will have to start accepting Medicaid patients or any patients eligible for state or federal assistance or allow the local health department to take over their services. The Owensboro health department and Danville's Ephraim McDowell Regional Medical Center "are two medical facilities that have absorbed formerly non-profit clinics," Downs reports.

Family Health Centers, which has seven community health clinics in Louisville, is free for those who are unable to pay, but it also accepts insurance. Its primary concern is how their business will need to change in order to not lose patients to local private practices that only accept insurance, Abby Goodnough reports in The New York Times.

"They expect their patient load to double, even as they struggle to recruit doctors and other staff members," Goodnough reports.  The clinics have focused on improved customer service and efficiency as they prepare for the expected changes the health care reform will bring. These efforts include: installing an appointment system instead of the current first-come, first-serve system, improving their facilities through the money allotted in the health care reform and converting to electronic medical records.

UPDATE, Dec. 21: The New Hope Clinic in Bath County "expects to continue serving patients who fall through the cracks," reports cn|2, a service of Time Warner Cable. Clinic Director Bill Grimes told senior reporter Don Weber that the expansion of Medicaid to households with incomes up to 138 percent of the federal poverty level will cover about 2,000 of the clinic's 2,700 patients. "Julia Maness, a nurse practitioner who is one of the New Hope Clinic?s co-founders, says she expects the first year under the Affordable Care Act to expose many issues that cause individuals to fall through the cracks," Weber reports.

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