I'm sharing this article from Sister Mary Ellen Howard - the Executive Director of Cabrini Clinic in Detroit.

Many people in the community — even those close to our clinic — are asking what will be the effect of the Affordable Care Act on the Cabrini Clinic and other providers of charitable care around the state. Some wonder whether we will continue to be needed, and whether they should still support us.
There are a lot of myths out there about health care reform. But here are some facts. In 2014, the ACA will offer two new opportunities for insurance coverage:
■ One is to purchase insurance through the exchange. Small businesses and anyone whose income is below 400% of the federal poverty level may receive a tax subsidy to help them buy coverage. However, most of our patients at the Cabrini Clinic are too poor to take advantage of this option.
■ The second is Medicaid expansion, and that is more likely to affect the uninsured people served by free clinics. Up until now, many have been excluded from Medicaid, not because they have too much income, but because they are childless adults. Under the ACA, childless adults become eligible for Medicaid. In Michigan, this take effect in April.
Michigan is one of the 25 states where the legislature voted for Medicaid expansion, albeit reluctantly. Statewide, it is estimated that more than 400,000 of Michigan’s 1.3 million uninsured will people become eligible for Medicaid.
I was hopeful that about 80% of the uninsured patients we see at Cabrini Clinic would be among them. However, the Michigan Legislature asked the U.S. Department of Health and Human Services for waivers on the program that it is calling Healthy Michigan. Federal approval is required because the Michigan plan varies from the Medicaid expansion outlined in the Affordable Care Act.
For the uninsured poor, these waivers will pose barriers. They require enrollees in Healthy Michigan to establish a health savings account from which the state will deduct an income-based monthly premium for those earning between 100 and 133% of the federal poverty level.
The premiums can be reduced through healthy behaviors. The plan also requires co-pays for basic services. These premiums and co-pays will be a barrier to poor people who need care. I wonder how many will actually sign up. I am beginning to think that my 80% projection was wildly optimistic.
To make matters worse, Michigan plans to seek a second waiver in the future, imposing a soft cap on coverage at 48-months, at which point recipients would be cut off from Medicaid for life.
Michigan still has not received a ruling from the federal government on the waivers, so we are stuck with a lot of unanswered questions.
What if the feds say “no” to Michigan’s requested waivers? Do we become the 26th state to refuse the opportunity to expand Medicaid? Enrollment is to begin in April. Now is when we should be educating the 1.3 million uninsured Michiganders regarding Medicaid expansion — what is coming, what it will mean, who is eligible, what do I have to do to enroll and what will it cost? Instead, we have no answers.
There are many unknowns, but the future of free clinics for the uninsured is not one of them. In fact, it appears that we are needed more than ever.
Mary Ellen Howard, RSM, is executive director of St. Frances Cabrini Clinic of Most Holy Trinity Church in Detroit.