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More Patients, Not Fewer, Turn to Health Clinics After Affordable Care Act

Many people ineligible for Medicaid in states that nixed program expansion

Nancy Hudson was the director of the Charlotte Community Health Clinic in North Carolina when the Patient Protection and Affordable Care Act (PPACA) rolled out. She expected the insurance exchange, or marketplace, established under the Act would reduce the number of uninsured patients the clinic sees, but the opposite happened, she told Kaiser Health News.

“What we found within our patient population and within the community is that a lot of the advertisements and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the [PPACA] marketplace,” Hudson said.

Now they get free or low-cost care at the clinic, which is designated by the government as a federally qualified health center (FQHC).

The PPACA was designed to cover the poorest people by expanding Medicaid, the federal–state program for low-income people –– but the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies, Kaiser says. In North Carolina, approximately 319,000 people fall into the Medicaid gap.

“Over half of the people that we see would have been eligible for Medicaid expansion had the state elected to exercise that option,” said Ben Money, president of the association that represents North Carolina’s community health centers.

North Carolina is among the 21 states, including many in the South, that are saying “no” to Medicaid expansion. Louisiana is another.

Dr. Gary Wiltz, the CEO of 10 community health centers in the southwestern part of Louisiana, said other things are at play, too. The current economic recovery hasn’t reached many of the poorest people, and some who do qualify for PPACA subsidies say their options are still too expensive.

“The need keeps increasing, and I think that’s reflected throughout all the states,” he told Kaiser.

Wiltz, who also heads the board of directors for the National Association of Community Health Centers, said clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients, too.

Hudson pointed out another part of the PPACA that is helping to fuel the growth: additional funding for community health centers. Recently, she learned that her clinic is getting about $700,000 to expand in partnership with Goodwill.

“Many of their clients did not have any access to health care,” she said. “They can’t train for and sustain a job if they don’t have their basic needs taken care of, and health care is one of them.”

Nationwide, the federal government has estimated that its latest round of funding will lead to approximately 650,000 people getting better access to health care.

Source: Kaiser Health News; June 3 2015.


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