Tim Gaynor

Demand for free medical clinics still high after ‘Obamacare’ expansion

Nearly 11.7 million enrolled under the ACA this year, but working poor, retirees and immigrants fall through cracks

PHOENIX — Unable to afford a visit to the doctor, part-time baby sitter Gwen Reese suffered from itching skin and slow-healing sores on her feet because her diabetes went untreated.

After months of anxiety, she finally sought help at a free medical clinic in Phoenix, where she was seen by a doctor and given the prescription medication she desperately needed, at no cost.

“I was losing it,” she recalled as she chatted at the Mission of Mercy mobile clinic in central Phoenix, where about 100 patients were seen by a team of doctors and nurses. “This has changed my life to the point where I can have a life … I wouldn’t make it without this.”

Retired nurse Liz Osborn with a cabinet containing about 200 prescription medications available to patients at a free medical clinic in Phoenix.
Tim Gaynor

Reese is among 36 million people in the United States who remain without health insurance despite an expansion of Barack Obama’s signature Affordable Care Act (ACA), under which 11.7 million people signed up for coverage in state or federal marketplaces this year, up from 8 million last year.

A key safety net for those without coverage are the more than 1,200 free and charitable clinics across the country, which have seen a 40 percent bump in patient demand since 2012, for services for everything from pediatric vaccinations to long-term management of diabetes for adults, according to the National Association of Free and Charitable Clinics (NAFCC). 

Widely referred to as ‘Obamacare,’ the ACA seeks to boost access, affordability and quality of health care by expanding eligibility and federal funding for Medicaid, the government’s health care program for low-income families and individuals while signing up millions more people for a variety of private coverage options through the health insurance marketplace. Enrollment for a second year in the marketplace closed last month.

Those falling through the cracks include many of the working poor who do not qualify for Medicaid but cannot afford insurance premiums and related out-of-pocket medical costs, those living in states that rejected the Medicaid expansion and millions of immigrants living and working in the country illegally, who are prohibited from applying.

Free clinics, which rely on donations, treated about 3 million people nationwide last year, according to the clinic association. Among facilities providing no-cost care in the Phoenix valley are six mobile clinics run by nonprofit Mission of Mercy, which last year provided primary care to up to 8,000 people in the metro area through more than 15,000 patient visits. The medical team includes doctors and nurses — many of them retirees donating their time — assisted by volunteer receptionists, medical interpreters, drivers and recordkeepers.

“Even though the Affordable Care Act has brought in a lot of people to be covered across the country, there’s still a huge gap,” said Paula Carvalho, a program manager with Mission of Mercy in Phoenix, which receives about two dozen calls a day from new patients seeking help. “There is far greater need than we could ever provide for.”

The organization, which is headquartered in Pennsylvania and also operates clinics in Maryland and Texas, offers a range of assistance to patients, from medical treatment to diagnostic and prescription services. Collaborative relationships with local hospitals and specialty care providers allows patients to receive additional no-cost care, including lab tests and X-rays.

‘Even though the Affordable Care Act has brought in a lot of people to be covered across the country, there’s still a huge gap. There is far greater need than we could ever provide for.’

Paula Carvalho

program manager, Mission of Mercy

The Obama administration said that more than half of consumers could get health insurance coverage for $100 or less through the ACA after tax credits. But with deductibles, co-pays and prescription costs that frequently run to thousands of dollars a year, care remains beyond the reach of millions of low- and middle- income people.

The Affordable Care Act “sounds good, but a lot of us … it’s not a part of our lives, because we can’t afford that. It’s not affordable to me,” said Reese, who gets by on money she earns baby-sitting and with help from her daughter-in-law. The cost of just the medication to treat her diabetes, which she estimated runs $300 a month, is too much for her.

Awaiting a checkup at the bustling free clinic at the Shepherd of the Valley Lutheran Church hall in central Phoenix was Sue Miller, a widow in her early 60s who retired from a job at a drugstore, where she worked part-time. While she receives Social Security, she is not yet eligible for Medicare, which is for people 65 or older, and could not afford to pay an insurance premium through the state health exchange costing $98 a month.

“What I found was that the price, like, doubled since last year,” she said as she sat on a folding chair, waiting to see one of several doctors, among them a retired surgeon and an emergency room doctor who both donated their time. “I pay rent and utilities, and that comes first. It has to. You have to have a place to live.”

The original ACA, enacted in 2010, included a nationwide expansion of Medicaid to include people with annual income of up to 138 percent of the federal poverty level (in 2015, $16,243 for one person and $33,465 for a family of four). In 2012 the Supreme Court upheld the ACA but allowed states to opt out of expanding Medicaid. Many Republicans opposed the expansion, and 22 states have rejected or are still discussing it, including Florida, where demand for free clinics is high.

Some 60 percent of patients seeking care at the nonprofit Grace Medical Home, a free clinic in Orlando offering a range of primary care, from checkups to vaccinations, are those on low incomes who fell into the “doughnut hole” that the opt-out created.

“They don’t qualify for subsidies with the Affordable Care Act, and they don’t qualify for Medicaid,” said the clinic’s executive director, Stephanie Garris. Grace Medical Home has treated some 2,400 patients since it began operations five years ago. “So in our case, we say everything’s changed but nothing’s changed. There’s still a huge demand for our services.”

Also slipping through the cracks are some 11 million immigrants living in the U.S. without permission, for whom access to care remains limited because they are prohibited from taking part in the health care exchanges created under the ACA. They account for more than half the patients visiting Mission of Mercy clinics across the Phoenix valley.

“The biggest problem with the vast majority of the patients is they are undocumented, mostly non-English-speaking people from Mexico. They have no Medicare or Medicaid, so they’re really stuck,” said Eugene “Speedy” Zweiback, a retired vascular surgeon from Nebraska. He believes health care should be “a right, not a privilege” for all and that immigrants should receive it regardless of their status simply “because they’re here.”

Among patients waiting to see a doctor at the Shepherd of the Valley clinic was Yolanda Leon, a grandmother from Mexico, who has diabetes. She received a medical checkup and a no-cost repeat prescription provided by the organization’s mobile pharmacy, which carries over 200 generic prescription medications.

“It would be very difficult for us” without the clinic’s help, said Leon, who was indignant that she was disqualified from buying health insurance because of her immigration status.

“It strikes me as racist, because we all pay rent, we all pay the bills, we all buy food, we pay what we have to pay, whether we are undocumented or residents or citizens ... So I don’t understand why there is no chance for those of us without papers to participate in the program,” she said.

The clinic proved vital for Adriana Lopez, a Mexican mother of three who sought a consultation last year after finding a lump in her breast. Referred by her primary care doctor to an oncologist, she was diagnosed with stage 4 metastatic breast cancer and received surgery and other treatments.

“To me, they’re angels,” she said of the organization, which runs on donations and goodwill in the shadow of a system full of holes. “All of them are big-hearted people, very beautiful people.”

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