Is the Clinic Still Needed?

St. Peter’s Free Clinic opened 11 ½ years ago with a mission to provide healthcare services to the low-income, uninsured residents of Hillsdale County. During this time, we have provided nearly 29,000 visits to 4,385 individuals and dispensed medications with a retail value of $9.8 million.

So, now the question is: do we still need the clinic?

The easy answer is yes; but it is much more complicated than that.

We serve a very vulnerable population, and we have no desire or plan to go away anytime soon. When I spoke with JJ Hodshire from Hillsdale Community Health Center, he said, “We continue to support St. Peter’s Free Clinic and see the clinic as an important part of the healthcare safety net in the foreseeable future.”

What he meant by that is that the clinic is part of the healthcare safety net system, made up of public and private institutions that deliver care in a variety of settings to individuals who are otherwise unable to afford or access care. Healthcare safety net providers, such as St. Peter’s Free Clinic, serve a diverse population including the working poor, the homeless, the undocumented and the uninsured, and in some cases, those with Medicaid. This group is included because of the difficulty in obtaining care – many providers choose not to provide care to those with Medicaid. In the past, the clinic has only provided care to those with Medicaid if they had a spend-down that made access to care impossible. We will evaluate the future of providing care to those with Medicaid as the situation plays out… can they access care? Can they afford care? Can they afford medications?

There are some who will remain uninsured either because of eligibility restrictions, insufficient subsidies that cause premiums to be unaffordable, or other barriers.

Some who “fall through the cracks” of healthcare reform include: the patient I have worked with to access healthcare through the Marketplace – with the subsidies, her insurance was going to be around $42/month. But, before her first premium was paid, the brakes went out on her car, and she had to have that fixed, in order to keep her job. She was living paycheck to paycheck – or more likely, paycheck to Thursday. And, she couldn’t pay the healthcare premium. She called the insurance company, but her policy was cancelled. Then, her hours were cut – from 40 per week to 25 per week. She now has no money to pay for healthcare, she isn’t eligible for additional subsidies because of the cancellation for non-payment of her premium, and she doesn’t qualify for Medicaid, even with her reduced hours.

Prior to the implementation of the Affordable Care Act, there were 41 million uninsured individuals in the United States; free clinics across the nation provided care to approximately 1.5 million of the uninsured. The Congressional Budget Office (CBO) predicts there will still be an estimated 29 million people in the United States without health insurance by 2019. So, even with the decrease in the number of uninsured, the need for free clinics will still exist.

The experience of free clinics in Vermont, Wisconsin, and Massachusetts – states where most of the uninsured received coverage due to federal waivers to expand Medicaid prior to implementation of the Affordable Care Act – show us the following:

v None of the free clinics closed; in fact, volume continued to grow.

v Free clinics helped enroll and navigate patients through the changes.

v Primary Care Provider (PCP) shortages, especially of PCPs who will accept Medicaid, resulted in free clinics providing care to Medicaid patients but not billing.

v Dental Care and Prescription Assistance remain huge gaps in service.

 

Today, the clinic continues to serve as many people as ever. For the first quarter of this year, we have seen an average of 57 patients per week with 73 new patients so far this year. We have dispensed medications with a retail value of $390,000.

Connie and I took the training in November to become Certified Application Counselors, and assisted individuals in applying for healthcare coverage through the Marketplace. We are continuing to assist with enrollment in the Healthy Michigan Plan, which is the Michigan version of Medicaid expansion – a program that provides healthcare to low-income working families. We have assisted over 60 individuals and families with applying for and enrolling in healthcare.

Obviously, the future of the clinic depends greatly on the availability of ongoing and sustainable funding. While the perception may be that the problem is fixed, it will not be an instant fix. It will take us months, probably years, to get everyone enrolled, and there will always be those who fall through the cracks. The support of our community is more important than ever.

Moving forward, the clinic will continue to provide healthcare, medications and other services to those who remain uninsured, as well as screening, enrolling in the appropriate healthcare product, and assisting with the transition to a primary care provider.

Enrollment in insurance through healthcare.gov is closed for now; the next open enrollment will begin November 15, 2014. The Healthy Michigan Plan enrollment is open all year round, so we will continuously be identifying those eligible for that program and assisting them as needed with enrollment.

The clinic is also looking at other services that are needed – we are offering a smoking cessation group; education on becoming a healthcare consumer; and we continue to assist individuals with finding the resources they need for a variety of issues including dental care and mental healthcare.

Moving forward, the board is constantly asking and discussing the future of the clinic, with questions such as:

—  What is the impact of the Affordable Care Act on our clinic?

—  How many of our patients will receive insurance coverage under the Affordable Care Act?

—  Where will they find care?

—  Who will remain uninsured in our community?

—  Will our clinic be needed post-2019?  Who will we serve?

—  What do we need to do to prepare for changes brought on by the Affordable Care Act?

—  What options are open to us for the future?

 

We are really excited as we help people access healthcare insurance; it has been a frustrating, crazy, but exciting, time. And, we look forward to continuing to provide healthcare to the low-income, uninsured residents of Hillsdale County – for as long as we are needed.