Wednesday, December 21, 2016

Free Clinics & ACA Uncertainty

As the Affordable Care Act (ACA, or more colloquially "Obamacare") began nation-wide implementation in 2014 there was a general sense of uncertainty around how free clinics would fit into the new healthcare landscape. While there was obvious excitement about patients being able to receive quality, insured care, free clinics were concerned that patients who continued to be uninsured would lose what became assumed access. The Arlington Free Clinic made sure to note at the bottom of their questions section that they would still need to be supported, likely through private donations, even as their patients transitioned into coverage.

This concern was not unwarranted, and in December of that year The Wall Street Journal reported that many free clinics had, in fact, closed because their patients now had insurance. This was especially true in states that expanded their Medicare Coverage. " 'As soon as there was the perception of universal health care, the likelihood of receiving donations goes down,’ said Colin McRae, a lawyer who served on the board [of Savannah’s Community Health Mission in Georgia]. This perception was acutely evident witnessing the 20% drop in donations experienced within 2012-2014 to free clinics across the U.S.

In the following year the imminent need of free clinics was made readily apparent as flaws and loopholes emerged in the ACA. "A key safety net for those without coverage are the more than 1,200 free and charitable clinics across the country," Al-Jazeera English reported,  "which have seen a 40 percent bump in patient demand since 2012." Even with insurance for under $100 a month, the other costs of deductibles and prescription drugs added up to something that was unaffordable for the working poor, in particular.

Part of the issue was that many states did not choose to expand Medicaid when the option was offered, meaning that those who were struggling the most financially didn't have direct access to low-cost care, but instead had to purchase through private insurance. The "Healthcare Marketplace" took back seat to actual marketplaces, where consumers were already having to make difficult choices on what to spend.

Moving forward we arrive in the present, where our president elect has vowed to "Completely repeal Obamacare" among a series of other proposed reforms that would encourage "free market" interventions to the lower cost of care and prescription drugs, introduce health savings accounts to cover costs while keeping individual expense down, and stiffen federal spending to states that have been receiving Medicaid grants.

This last part is most alarming given that it is already what has prevented the most in need of insurance to get insurance in the first place. At the root of the matter is that "Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA… uninsured visits remain high, especially in states that opted out of Medicaid expansion." even in 2016.

President Elect Trump's opinions on this have shifted since his victory, suggesting that he will not likely completely dismantle the bill. "Mr. Trump even indicated that he would like to keep two of the most popular benefits of the Affordable Care Act, one that forces insurers to cover people with pre-existing health conditions and another that allows parents to cover children under their plan into their mid-20s." says the New York Times. This a victory for 20-somethings and people with prior conditions, but notice who is still missing-- the working poor, again, who evaded benefits of the act in the first place.

Looping back around, the New York Times suggests that "The health care industry, which invested hundreds of millions of dollars in preparing for business under the Affordable Care Act, is disoriented about what to do [after Trump’s election] — and scrambling for ways to avoid a financial shock."

The unfortunate irony is that the the working poor are already acutely aware of this uncertainty and are already feeling it in the health care sector. It would be unfortunate if any reforms leave more people in this place.

Knowing that the future is unknown and that the need will be unmet regardless of the outcome with the ACA we can be confident that Promise Clinic’s necessary place in serving the New Brunswick community is by no means in jeopardy. In fact, one could say the position never changed; knowing that a majority of our patients when transferred out are transferred to Medicaid/Medicare suggests that through all the changes that have occurred since 2014 they would continue to be undeserved in 2017 and to come.

Our role is to continue to keep our doors open and serve them for as long as we are needed- one of our ultimate goals being that we will no longer be needed.

No comments:

Post a Comment