Free Va. clinics brace for surge

Blows to Virginia's health care system will come in waves over the next 24 months, with an estimated total of more than 300,000 Virginians losing their health insurance due to federal policy changes.

As the General Assembly examines strategies to support health care access and aff ordability for residents, increasing funding for Virginia's free and charitable clinics is one of the smartest and most cost-eff ective solutions on the table. Knowing this, Del. Rodney Willett and Sen. Mamie Locke have sponsored budget amendments to stabilize Virginia's network of free and charitable clinics.

It's also the most prudent solution as clinics will experience the first wave of impact should Congress not extend the Aff ordable Care Act's enhanced premium tax credits. Without those, thousands of Virginians will be priced out of the Aff ordable Care Act marketplace, many of whom are frontline employees or small business owners who can't aff ord the expected increases by as much as 40%.

Clinics are currently operating under extreme pressure. Between 2022 and 2024, they saw a staggering 43% increase in uninsured, underinsured and Medicaid patients, with a combination of factors driving this increase in demand, including the need for dental and behavioral health services. At the same time, clinics are navigating higher costs for health care supplies and the loss of volunteer providers, forcing them to have higher-paid staff .

Over the past decade, the cost of care at free clinics went up 178%, going from $353 to $982 annually per patient, driven by more complex and diverse patient needs. While significant, it is still well under the $2,500 average cost of a single hospital ER visit, according to a 2022 Kaiser Family Foundation and Peterson Center on Healthcare report.

The math is straightforward; do we invest in clinics to manage a patient's hypertension or diabetes in a clinic setting, or wait for them to suff er a crisis and pay $2,500 (or more) for an emergency room visit that the taxpayer or the hospital eventually absorbs? Research shows that when people lack insurance, they delay care, leading to avoidable hospitalizations and often crushing medical debt.

Inflation, economic strain and changes to insurance coverage will create a devastating surge in the number of our neighbors who are uninsured, underinsured and vulnerable. Typically, this is where clinics step in as an essential health care safety net of compassionate, high-quality care delivering medical, dental, vision, speech, hearing, behavioral health, prescription medications and substance use disorder programs that help keep uninsured and underinsured patients out of hospital settings. However, for that to happen this time, significantly more funding is needed for clinics to remain sustainable, given the ongoing rise in both patient demand and operating costs.

Free and charitable clinics are vital to the health of our community and economy, but rising health care costs, coupled with inadequate state funding and increased patient demand, have put their sustainability at risk.

Rufus Phillips is CEO of the Virginia Association of Free & Charitable Clinics. He can be reached at rufus@vafreeclinics.org.