Tompkins Weekly  11-11-13

By Abbe Lyons

With the Affordable Care Act (ACA) in the news, health insurance and health care are on many people’s minds. The good news is that health insurance coverage will be more widely available, and for some, there is financial assistance that may make it more affordable. The choices are complex. If you are overwhelmed, one of our local navigators (call 2-1-1 for an appointment), certified application counselors or brokers can help – they have all received special training on the NY  State of Health website (our state health insurance exchange) and  the ins and outs of various plans. However, access to health insurance does not equal access to health care. That’s where Free Clinics come in.

Two interesting questions we have been getting at the Ithaca Health Alliance are: “will Ithaca Free Clinic (IFC) still be needed?” (yes), and “does the Clinic receive funding from the ACA?” (no). These questions were discussed extensively at the National Association of Free and Charitable Clinics’ (NAFCC) annual Summit in Baltimore at the end of October. The Free Clinics movement, which began in the 1960s on the principle that health care is a right and not a privilege, consists of many local, community-based responses to holes in the safety net. Free Clinics don’t just provide free care – they seek to engage patients actively in their own health care. There are over 1200 free and charitable clinics in the US serving over 50 million uninsured Americans. The ACA will help only 34 million  people get health insurance (in our region, over 23,000 will remain uninsured). While there is ample funding for efforts to sign people up for health insurance, but it is unclear whether there are enough primary care providers will be to take care of the newly insured, including many new Medicaid patients thanks to expanded Medicaid eligibility under the ACA.

Yes, free clinics will still be needed to help those who still won’t have access to health insurance, for those whose communities lack enough doctors, those who face out of pocket costs they cannot afford. Free clinics will continue to meet other gaps not addressed by the ACA, such as dental care. In Massachusetts, with a 97% insurance rate, free clinics are still needed. Free clinics do not receive funding through the ACA and most free clinics (including IFC) do not receive state or federal funding.

Since 2006, more than 6,000 people from all walks of life have visited Ithaca Free Clinic. Like 83 percent of free clinic patients nationwide, most are working adults whose income is too high for public insurance but too low for them to afford health insurance or out-of-pocket medical costs. Many will be hard-pressed to purchase health insurance, even with ACA financial assistance, or to afford co-pays for doctor visits without cutting into their tightly budgeted expenses for rent, utilities, food, and transportation. Most of the holistic and therapeutic services offered at Ithaca Free Clinic will not be affected by the ACA, because they aren’t covered by most insurance.

Sustainability in health care requires good education and fair treatment for all our health care providers: for our doctors and nurses, our medical office staff, our acupuncturists and chiropractors, our mental health professionals, our health educators, and for the most primary healthcare providers of all:  ourselves, our parents, our children, and our family members. Sustainability in health care requires that we have enough professional providers to meet the needs of our communities, and that they are able to practice in a way that supports their own good health. Sustainability in health care means determining the financial and non-financial barriers that limit people’s access to health care, and providing a safety net for those who would otherwise fall through the cracks. Sustainability in health care requires considering the social, economic and environmental determinants of good health and poor health.

The first free clinics focused on providing care for our American “untouchables.” At a free clinic, you could get health care without harassment, even if you couldn’t pay for it. At a free clinic, you could get tested for sexually transmitted diseases without being shamed. You didn’t have to pay in money – or in abasement. Today, free clinics and community health organizations like the Ithaca Health Alliance are still needed to provide care in a respectful environment, to fill in the gaps and address the barriers that prevent people from accessing care, and to provide an entry point into existing healthcare systems. Let’s work together towards sustainable health care!

Abbe Lyons is the Executive Director of the Ithaca Health Alliance, whose programs include Ithaca Free Clinic, Ithaca Health Fund, and Community Health Education.