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Many thanks to the board of the Free Clinic of Southwest Washington for addressing these common questions.
How has the Affordable Care Act (ACA) impacted free clinic visits in Washington?
Some free clinics are seeing a drop in patient visits, but it varies by program: medical versus dental, chronic versus acute. With seasonal volumes and transitions in Medicaid and the Washington State Insurance Exchange, it is too early to tell what the long term trend is going to be. Many free clinics are seeing more individuals with Medicaid seeking urgent medical and dental care because they cannot find access in the community. Across all programs, there are still uninsured individuals who need care.
What services are covered under the Affordable Care Act?
The Affordable Care Act requires health plans offered in the individual and small group markets, both inside and outside of the health insurance marketplace, to offer a comprehensive package of items and services, known as Essential Health Benefits.
Essential Health Benefits must include items and services within at least the following ten categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services.
In the State of Washington, dental and vision care are also provided for Medicaid patients.
Now that everyone has insurance, what will happen to the free clinics?
Insurance does not equal access to healthcare.
Not everyone will have insurance with the Affordable Care Act. At full implementation, there will continue to be uninsured individuals across the state. In many communities, there are not enough providers to serve the new Medicaid and Medicare population. There may be additional opportunities for free clinics to partner with health partners to address community capacity.
It is also anticipated that there will be a significant population of newly insured people who cannot afford their deductibles and copays, resulting in a larger “underinsured” population.
The existing network of free clinics across the country serves approximately two million people, so there will be a continued role for free clinics. There may be changes in the demographics of populations served by free clinics.
According to Kaiser Health News, silver plan insurers will cover approximately 70% of costs, leaving consumer responsible for remaining 30%. Bronze plans, the plans with the lowest premiums but highest deductible, leave the consumer to pay about 40% of medical costs out of pocket. Low income individuals with chronic illnesses are at particular risk of not being able to afford care under this plan. If they purchased bronze or silver plans, they are likely to hit their out of pocket maximums.
Will there still be a need for volunteers post-ACA?
Yes. Volunteers are the lifeblood of the free and charitable clinic network! As long as there are still patients needing care, volunteer providers will be necessary to meet that need.
Won’t the number of non-English speaking patients increase and how are going to assist them?
Currently, across the state, many free clinics are seeing a higher proportion of non-English speaking patients. Many clinics are actively recruiting volunteers who are multilingual, in order to better serve their patient population.
What is cost of average health plan for family of four? What is the correct poverty level acceptance point?
Go to Washington healthplanfinder to determine for family of four. Individuals up to 138% of the federal poverty level may qualify for Medicaid.
In addition to a shortage of primary care providers for the increased number of patients with insurance or Medicaid coverage, is there also a shortage of facilities?
Yes, if the healthcare systems could solve the provider shortages, there is also a shortage of facilities, primary care, hospital emergency rooms, etc.
If a patient has Medicaid, can he/she still come to a free clinic for care?
In most cases, yes. The free clinics encourage people to find a provider and a primary care home in order to have sustained care, however most free clinics will accept individuals who come for urgent needs and have not been able to access care elsewhere.
