3 February 2023

Health Law Hurts Some Free Clinics

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Some free health clinics serving the uninsured are shutting their doors because of funding shortfalls and low demand they attribute to the Affordable Care Act’s insurance expansion. Nearly a dozen clinics that have closed in the past two years cited the federal health law as a major reason.

The closings have occurred largely in 28 states and Washington, D.C., which all expanded Medicaid, the federal-state insurance program for low-income people, and are being heralded by some clinic officials as a sign the health law is reducing the number of uninsured. But the closures have irked some patients and left pockets of uninsured people not covered by the law with fewer venues for care. Some of the roughly 1,200 U.S. free and charity clinics are struggling with a drop in funding because donors believe there is no longer a need for free or low-cost care in the wake of the health law. That is making it particularly difficult for clinics that still report strong demand, especially in states that didn’t expand Medicaid.

Over the past two years, donations to free and charity clinics, which in some cases charge nominal or sliding fees, have dropped 20%, according to a report this year by the National Association of Free and Charitable Clinics. During that time, patient demand has risen 40%. While some clinics are closing, others are reinventing themselves. Some are accepting Medicaid while also offering free services. Others are launching dental care or mental-health services to augment their offerings.

Free and charity-based clinics see about 5.5 million visits annually, and less than half have an operating budget under $100,000. The 2010 health law set aside $11 billion to fund community health centers, a designation that applies to clinics that meet certain requirements such as charging sliding-fee scales and having a board of directors. Many clinics that serve the poor don’t get that funding and rely instead on donations and grants to provide medical, dental, pharmacy, vision and behavioral-health services.

The Western Stark Free Clinic in Massillon, Ohio, was scheduled to close this month. The 15-year-old clinic experienced a 30% drop in patients since the beginning of the year because many are now eligible for Medicaid. The Good Samaritan Free Clinic in Rock Island, Ill., opened about seven years ago and provided primary care for the uninsured for no cost. The clinic closed in the spring because its directors felt there was no longer a need following the rollout of the health law.

The health law also led to the closure in February of the No-Fee Chronic Disease Medical Clinic in Olympia, Wash. The volunteer clinic provided care to about 650 people with illnesses such as diabetes, asthma and hypertension and who had no medical insurance. It saw many patients move to Medicaid when the program expanded this year.

More than one million Washington residents enrolled in health plans through the state’s exchange, dropping the state’s uninsured rate by 30%, according to the Washington Health Benefit Exchange. The health law will reduce the number of uninsured by 25 million by 2023, according to a May 2013 report by the Congressional Budget Office. That will still leave 31 million Americans without health insurance.

Click here to access the full article on The Wall Street Journal. 

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