By The Gazette Editorial Board
The federal Affordable Care Act is enrolling Iowans into various health care insurance options, albeit with lots of bumps and changes on the fly. The accompanying new Iowa Health and Wellness Plan — our state’s version of expanded Medicaid — is signing up more people who couldn’t otherwise afford coverage. As of mid-February, more than 13,000 Iowans who previously weren’t covered had enrolled.
So it might appear that the need for such local agencies as the Community Health Free Clinic and His Hands Free Medical Clinic in Cedar Rapids and the Iowa City Free Medical Clinic is going away.
While the national and state health plans are expected to provide coverage to more than 30 million of the nation’s nearly 50 million uninsured, about 18 million likely won’t be covered when the initial ACA enrollment period ends March 31.
GAPS IN COVERAGE
The free clinics have traditionally provided health services to a range of low-income people who are underinsured or not insured. The revised outlook is that more of those folks should be covered under the reforms. But many of those whose incomes fall between 134 percent of the federal poverty level — where the Iowa plan leaves off — and about 200 percent of the FPL will slip into a coverage crack. Referred to as the “working poor,” many of them have jobs that don’t provide insurance through their employers or don’t pay enough for them to afford even the subsidized premiums, deductibles and copays available on the ACA’s Marketplace of options.
Darlene Schmidt, co-founder and CEO of the Community Health Free Clinic, told us it will be at least six months before the picture is in better focus, but she expects there still will be a substantial number of residents who need the clinic’s medical, prescription, dental, vision or referral services.
“We welcome the new reforms because many more low-income people will have a medical home and more continuity of care that is so important,” Schmidt said. “But there will be gaps.”
Barbara Vinograde, executive director of the Iowa City Free Medical Clinic, agrees. “We’ve had a lot of patients already who have gone to the website and can’t find an affordable plan, even with subsidies,” she told us.
“I also think another challenge for people who do qualify for expanded Medicaid is that it will take some time to determine if they’re actually getting access to care, not just insurance.” That’s because an estimated 150,000 more Iowans are expected to enroll within the next three years, straining existing resources and primary care physicians — already in increasingly short supply — to provide enough services and those medical homes.
“I hope the safety net will be enough ... but we can’t assume it will be right now,” Vinograde added.
And without free clinics available those falling into the coverage gaps likely will increase their use of expensive emergency rooms for non-emergency purposes.
Jeff Tourdot, the specialist who is coordinating a Linn County partnership of agencies that is providing information and signup assistance for the new health care options, concurs that the reforms in place aren’t the full solution.
“With this reality acknowledged, it is important to recognize the value both the Community Health Free Clinic and His Hands Free Clinic continue to provide our community,” he wrote.
Those two clinics have the same roots, first opening as the Cedar Rapids Free Medical Clinic in 1992 within the Jane Boyd Community House — the community’s first free clinic.
In 2002, a separate Community Health Free Clinic was born under the leadership of Schmidt, with experience as a nurse, and Dr. William Galbraith, while His Hands Ministries remained committed to its spiritual-based mission of care through the His Hands Free Clinic.
Last fiscal year, 13,627 people — up 11,024 from the previous year — were served by the Community Health Free Clinic. More than 1,000 were helped at His Hands Free Clinic.
The Iowa City Free Medical Clinic, established in 1971, last year served more than 2,000 patients.
The number of patient services and visits at all sites is much higher. Chronic illnesses have been on the rise in the past decade and require more frequent treatment.
All three free clinics are non-profit organizations dependent on financial donations and in-kind contributions from individuals, companies, churches and foundations. With only a collective handful of paid staff, they rely heavily on hundreds of people who volunteer their time and expertise, including doctors, nurse practitioners and nurses, and pharmacists.
VOLUNTEERS ARE VITAL
The largest operation, Community Health Free Clinic, has an annual operating budget of $1 million. By leveraging its volunteers and donations, clinic officials figure $13 worth of health care is delivered for every $1 in that budget.
Galbraith, a physician well past traditional retirement age, has been a consummate volunteer at the clinic he helped found. He told us it’s getting more difficult to recruit young physicians to volunteer — many are carrying heavy debt loads from their medical school costs, and the majority are employed by large organizations and have less flexibility than Galbraith had during his career.
That’s a problem because the clinic needs 4-6 doctors and/or certified practitioners per shift to meet the demand for care. He’s appealing to the baby boomer generation, many retired or approaching retirement, to find more volunteers.
He also told us the clinic continues not to take federal funding because “it entangles you in so much red tape. We want to maintain our freedom, and we’re supported by many people and organizations.”
Our Corridor communities have supported these clinics for decades, often generously. Now, as Vinograde said, “we must challenge the assumption that free clinics are no longer needed.”
Clearly, they are, and substantial community support will remain vital for at least the near future.
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More on Corridor free clinics:
Community Health Free Clinic, Cedar Rapids
His Hands Free Medical Clinic, Cedar Rapids
Iowa City Free Medical Clinichttp://freemedicalclinic.org/