Clinical analysis

This past summer WORLD sent reporters to visit charity clinics across the country. Their job: to describe the existing healthcare safety net for the uninsured. As we reported in the Sept. 22 issue, our writers visited clinics in a dozen states and talked to doctors at many more.

Our reporters uncovered four common themes: Create networks of care, change patient behavior, recruit volunteers, and find freedom from bureaucracy. The September issue included stories about networks of care and bureaucracy. In the pages that follow, you will read how clinics recruit volunteers and undertake the slow, crucial work of changing patient behavior.

When we began our research, we planned to focus on privately funded charity clinics. But in the course of their research, our reporters discovered that in many urban and rural areas, where many people qualify for Medicaid and Medicare, faith-based Federally Qualified Health Centers (FQHCs) allow Christian doctors to provide compassionate care while working within an often frustrating system.

Dr. David Kim, founder of Beacon Health Center on Staten Island, acknowledges the red tape FQHCs face, but he says those challenges do not negate the calling we “have received from God to be a ‘faithful presence’ in that world, even as Daniel, Shadrach, Meshach and Abednego were in theirs.”

He says many Christian FQHCs receive local and national recognition for the quality of care they provide, adding, “Even in the darkness, God is allowing us in the FQHC world, and those serving in other darker parts of our country and world, to be bearers of His light.”

As we wait for election results to determine the future of Obamacare, charity clinic leaders do not have a clear picture of what the “Affordable Care Act” means for their organizations, but they know it will not eliminate the problem of uninsured individuals.

Wake Forest law and public health professor Mark Hall says that even after the act goes into effect, 20 million to 25 million people who are now uninsured will remain uninsured. Undocumented immigrants will be excluded from coverage under the law, and legal immigrants in the country fewer than five years are also uncovered.

The same goes for some middle-class individuals who do not qualify for subsidies but have a hard time affording premiums. It’s also not clear what millions of individuals will do if their companies drop their current insurance plans.

Pat White at West Virginia Health Right says many of her clients live day by day, and the requirement to pay a penalty, whether $90 or $5,000, will not lead them to sign up. Many of them also won’t sign up for Medicaid because they don’t want the government in their business. As long as the law requires people to fill out applications to enroll (rather than an automatic sign-up), they won’t. Healthcare just isn’t a priority, and thinking about it before they get sick would require “breaking a habit of how they have received healthcare.”

Hall thinks free clinics and Project Access–type referral networks might have to start offering services on a sliding scale (rather than for free): Donors and volunteers, he suggests, will not want to provide free care to middle-class individuals, and it will seem fairer if they pay something for those services.