After eight years of stagnant growth during Obamacare’s coverage expansion, free and charitable health clinics are experiencing a major growth spurt amid Republican efforts to slash health coverage for the poor.
A safety-net health care provider for low-income Americans, the nation’s 1,200-plus free clinics typically are underfunded, understaffed and overwhelmed by an outsized mission that far outstrips their limited resources. Forty-three percent have annual operating budgets under $100,000.
But as millions of people gained coverage under the Affordable Care Act, the number of clinics didn’t increase for eight years. In fact, the total number declined by 11 nationwide from 2009 to 2017 as more patients with insurance moved into mainstream medical care.
That negative growth rate ended abruptly this year, however. Fifty-two new free and charitable clinics – which receive no federal funding – are set to open in 2017. And 100 more will open next year, said Nicole Lamoureux, CEO of the National Association of Free and Charitable Clinics, based in Alexandria, Virginia.
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Florida leads all states with roughly 100 free and charitable clinics. At least four new ones have opened in recent months, said Nick Duran, executive director of the Florida Association of Free and Charitable Clinics, which has 12 member organizations in the county.
Florida is one of 19 states that have not expanded Medicaid, which left nearly a million people uninsured, many of whom were only able to obtain coverage under the Affordable Care Act. Within Florida, Miami-Dade County has the largest uninsured population.
“If the Affordable Care Act is repealed, you can expect that a lot of people are going to need more insurance…and that logically can lead to more clinics showing up” he said. “[Miami-Dade County] is going to be one of the best barometers for our growing uninsured population.”
Under the Affordable Care Act, Florida’s uninsured population decreased from 29 percent in 2013 to 20 percent in 2015, according to a study by the Commonwealth Fund.
“I think it’s going to lead to a lot of people showing up to the places [free clinics] that have been around for many years and all of a sudden the volume of patients actually needing their medical services will increase,” Duran said.
The burst of activity reflects both the unmet health care needs of the nation’s 29 million uninsured, but also the hardships posed by rising out-of-pocket costs for people with Medicaid and private coverage.
Many Medicaid enrollees – and some people with Obamacare insurance – simply can’t afford their co-pays and deductibles and instead seek care at clinics that charge nothing or only a modest fee for treatment, Lamoureux said.
Inability to utilize one’s coverage because of the cost is a frequent Republican complaint about Obamacare. President Donald Trump, Health and Human Services Secretary Tom Price, White House budget director Mick Mulvaney and House Speaker Paul Ryan, R-Wisc., all have cited the problem as evidence that Obamacare is crumbling.
But projected coverage losses under health care proposals from congressional Republicans and the Trump administration also are fueling renewed interest in clinics.
The House Republican health care bill would cut Medicaid spending by nearly $900 billion over the next decade and cause 23 million people to lose coverage over the same period. Senate Republicans are working on their own version behind closed doors, and there is expectation that they’ll pick up many of the same provisions.
“The explanation for why there may be an upsurge in clinics right now, I think, is the perception in our communities that there’s going to be a real need for this service,” said Randy Jordan, CEO of the North Carolina Association of Free and Charitable Clinics. “The discourse that’s taking place with health care in our country probably has stimulated some of that sense of need.”
Lamoureux agreed. Shortly after the Republican health bill passed the House of Representatives in early May, Lamoureux said her association received an unusual funding bump: $100,000 in donations, mostly from contributions of $40 or less.
Just six months ago, she said, most of the new clinic openings and development plans were due to the vast needs of the uninsured.
“But what I’m finding as I travel around the country talking, especially after this election and especially after passage of the House (Republican health care bill), now the conversation is, ‘How do we do more?’” Lamoureux said. “How do we open up clinics? … There are changes coming down the pipe. We need to ramp up and be ready.”
Unlike Community Health Centers that are federally funded, free and charitable clinics rely mainly on volunteer medical providers and private philanthropic funding. Typical supporters include local churches, businesses, hospitals, universities, foundations and other community organizations.
The clinics mainly serve the uninsured, underinsured and those with trouble accessing primary and specialty care, including undocumented immigrants. Most adult clinic patients have either diabetes or hypertension, Lamoureux said.
Free clinics first began appearing in the 1960s during the Johnson administration’s “War on Poverty.” Many thought the clinics would disappear after the Affordable Care Act was passed.
“Nothing could have been farther from the truth,” Lamoureux said, adding that 1.8 million people were treated at the nation’s 1,200 clinics in 2016. That’s 100,000 more than in 2015.
Miami Herald reporter Ayanna Runcie contributed to this report.