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A group of health care professionals express mixed feelings about the impact of health care reform on the 1.6 million of under- and uninsured North Carolinians and the 77 clinics and pharmacies across the state that provide free care.

They are also concerned about what they see as serious omissions from the bill.

As the debate on healthcare reform heats up, Jason Baisden, executive director for the North Carolina Association of Free Clinics is bemused that members of his organization are being shut out of the process.

“This is a national issue,” said Baisden. “We have no seat at the table. If they are talking about helping the under- and uninsured, you think they’d want to talk to those who deal solely with that population.”

NCAFC is part of the National Association of Free Clinics, the only non-profit organization whose mission it is to serve indigent people who do not qualify for Medicaid or Medicare and cannot afford private insurance or medical care—the very people reform is supposed to help.
Baisden said that by working directly with this population, they can provide lawmakers with valuable details and more insight into the basic needs of people most likely to be impacted by reform.

 The conscious decision to shut out free clinics from the debate may be due to a lack of awareness about them and the services they provide or an unstated belief that there’s services will no longer be necessary if reform is passed.
“They don’t understand what we do,” said Baisden.

A group of advocates went to Washington in June with the hopes of securing a seat at the table. “Ninety percent of the discussion was dominated by us trying to explain what a free clinic is,” he said.

When U.S. Senator Kay Hagan (D-N.C.) visited Shelter Services, one of Charlotte’s free clinics, to discuss health care in June, she was under the impression they received stimulus money and federal funding. She had no idea that they did not receive federal funds and the people they served, although they were often unemployed and homeless, did not qualify for Medicaid or Medicare.

Like many of her constituents, she had no understanding of the concept of a free clinic or did not fully grasp the plight of the uninsured people they served. Hagan was on the committee that drafted the health care reform bill.

Free clinics provide life saving care and offer an array of primary care services, chronic disease management and dental care. Some also provide specialty care, such as cancer screening, mental health care and vision screening. Free clinics do not use tax dollars, but rely on community support.

Of the various drafts of reform circulating in Washington, none includes financial assistance to the more than 1,200 free clinics in the U.S. Perhaps the notion is they will no longer be needed if the measure is passed. An ambition that advocates say is unrealistic.

Baisden said even if everyone could instantly have coverage, problems with the system would not go away entirely. People inevitably fall through the cracks. Free clinics provide care for them.

“You cannot develop a perfect system. There always seems to be gaps. You can close the gaps, but there still will be those in need, even when there is less need,” said Baisden.

Donna Murray Lacey, executive director of Charlotte Volunteers In Medicine, does not foresee reform making an immediate impact on clients. 
“If they can’t afford to purchase, they still need to be managed somewhere,” she said.

CVIM patient Elijah Scot said stumbling across the clinic was a godsend, as his diabetes has gone untreated for nearly two years. He lost his city job after 15 years and has not had any means to afford healthcare. His deteriorating health condition is making his search for work that much harder. “It’s debilitating,” he said.

Scot works odd jobs for room and board and said he is dismayed that the dogs that live in the home where he stays get better treatment. “They are able to go to the doctor and I can’t,” he said.

“It’s a shame we live in the most blessed country on the entire planet, and someone can’t go to the doctor—sad that people go without medical care because they are unable to pay.”

Lacey said that although she has her concerns about the current plan, it has benefits, including capping costs and extending care to those with pre-existing conditions.

“The reason for the revamp is to contain costs, so they will not continue to skyrocket,” she said.

Baisden agrees that reform is needed.

“It’s definitely needed,” said Baisden. “We have been going back and forth for years having creeping discussions, but they haven’t been profitable as a breakdown occurs in deciding on the details. Deciding how to reform the system is extremely complex,” he said. Deciding what to reform and how to pay for it have been the biggest dilemmas to address.

Baisden believes there are other issues the bill does not adequately address, such as the shortage of doctors, especially in rural areas.
More medical students are opting for specialized care instead of general practice. If universal health care coverage is provided, patients will rely on primary care providers and may face longer wait times.

“Doctors can only see so many people in a day,” said Baisden. ”These shortages will take a number of years, perhaps decades to change.”

Advocates say more should be done to encourage medical students to enter general practice and attract them to rural communities.

Another omission is there is no discussion of extending coverage to undocumented immigrants. Baisden warns there will be consequences.
“Anybody with no access to health care can potentially be a public health hazard, especially if they come from places that have not dealt with viruses that we have, and bring [diseases] with them” he said. “They may be working in restaurants and in our schools without receiving immunizations and bottom baseline care.”

“Public safety is number one. Our mission is not about debating whether or not they should be here. They are here and in need of care, and that’s where we start.”

Baisden said, those in need of care will access the emergency room if that is there only alternative. “Those costs will be absorbed in the system,” he said.

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Posted on May 27, 2010