Patients Flock To Free Clinics Despite ACA

Jan. 26--When the Affordable Care Act became law, Sandra Lozano looked forward to the day when the patients who rely on her free health clinic in Fort Lauderdale would be covered. But even though the new healthcare marketplace has finally launched, at the Light of the World clinic, it's like the ACA never happened.

"We're seeing a tremendous increase in people coming to us," said Lozano, executive director at the clinic, where applications for charitable care are up 25 percent since October.

From Miami to Key West, other free and low-cost clinics say they've seen little impact from Obamacare -- no drop-off in patient loads and sometimes even an increase, like the Fort Lauderdale clinic.

"We had 8,016 patient encounters last year and don't expect a change any time soon. We're looking to expand," Lozano said.

The nonprofit clinics, which are run largely by volunteers, provide healthcare to uninsured people with incomes up to 200 percent of the Federal Poverty Level (FPL). The ACA should provide an alternative for many of their patients, but it's not playing out that way so far, at least in South Florida.

Some of the clinic patients don't earn enough to qualify for a tax credit that would help them afford insurance premiums. Others lack the required immigration status. Still others are caught in lags between charitable and other coverage. Clinic staff members say that as long as Florida doesn't expand Medicaid, their services will be in demand.

The Florida Legislature rejected Medicaid expansion last year. A Miami-Dade County lawmaker has introduced a bill this year to reconsider the issue.

In Lozano's case, applicants tell her their certification for the free care they've been receiving at Broward Health and Memorial Healthcare System -- the two public health systems in Broward County -- is up for renewal and won't be continued if they qualify for Obamacare or Medicaid. "These individuals are in between or blocked out of services until they get approved, a process that could take months," Lozano said.

At another free clinic in Tavernier in the Florida Keys, executive director Jennifer Rickmann of Good Health Clinic said Obamacare is putting her operation out of business -- not because all her patients have enrolled in health plans, but because the clinic's donors expect them to.

"Because of Obamacare, funders are asking, 'What do we need you for?' " Rickmann said. Her answer? The 600 patients served by the clinic who haven't made the transition to private insurance. So far, only one -- Joe Marcum, a 57-year-old Tavernier man who earns $15,000 a year delivering newspapers -- has left Good Health for a subsidized Obamacare health plan.

At St. John Bosco Clinic in Miami, executive director Berta Cabrera hears the question, too. "The first thing donors ask is, 'Aren't you going to get coverage for your patients now?' and then 'Is the clinic going to get support because of the ACA?'" Cabrera said.

The clinic, which last year served 890 patients, offers primary care and basic specialties such as cardiology and ophthalmology, all free. Staff members refer patients to community navigators to learn about the healthcare marketplace, but Cabrera estimates that only 20 percent of them have incomes sufficient to qualify them for Obamacare tax credits.

"A lot of patients are confused about the ACA and have questions. They're concerned about the co-pay. They want to know how much they'll really have to pay," Cabrera said. To her knowledge, only one has enrolled on the healthcare exchange.

In Florida City, the Good News Care Center owned by the Miami Baptist Association is adding new patients every week. Founder and Chief Executive Michael Daily says many of the patients might be able to obtain coverage through the ACA, but there's a hitch.

"They can't afford the care because of the deductibles and co-pays. The practical value is zero," Daily said.

If patients meet the free clinic's criteria, Good News will accept them, ACA or not.

About 800,000 Floridians fall into what's known as the "coverage gap" -- too much income to receive Medicaid, but too little for a subsidized health plan. An estimated 460,000 undocumented residents also don't qualify for ACA health plans. The extent to which the two populations overlap is unknown.

"Undocumented people are automatically eligible for our clinic because they're not eligible for anything else," Daily said.

About 40 percent of Good News' clients are part-time or seasonal service and farm workers without a legal status. Homestead grower Costa Farms funds one of the two full-time doctors in exchange for having the clinic conduct health screenings for its workers on site.

St. John Bosco also serves many new immigrants. While Cabrera didn't give an estimate, immigration status is often a factor in disqualifying those who apply for Obamacare, she said.

The situation is different in Tavernier, where Rickmann says a large number of Good Health's patients could enroll in Obamacare. But paying premiums and co-pays can be a significant barrier.

"They're used to receiving healthcare for free," Rickmann said.

But Marcum, Good Health's lone Obamacare convert, prefers being insured. "As wonderful as the clinic is, it's not health insurance. It's a safety net to make sure you don't fall through the cracks," he said.

He calls his low-deductible "silver" plan "the best health insurance I've had since I lived with my parents. When people say repeal Obamacare, I say don't you dare."

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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