Imagine you wake up one morning with an agonizing pain in your stomach. You have already been to the emergency room for this problem once before and find yourself continually harassed by collection agencies for soaring medical bills built up from that one unavoidable visit. You don’t want to go back to the hospital and bury yourself even further into debt, but you don’t have health insurance or even enough cash in your bank account to go to a general physician or an urgent care facility. The pain is overwhelming and you want nothing more to see a doctor who could easily treat your problem, but the thought of digging yourself even deeper into a financial hole seems equally painful. So, where do you go? Who do you turn to?
In North Carolina, there are 82 free medical clinics located in 54 counties that serve 80 counties in the state. These clinics do phenomenal work, reaching out to our state’s most needy and providing free medical care to residents who would be completely without otherwise. Nationally, “[f]ree and charitable clinics are safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to economically disadvantaged individuals.” 
North Carolina is known to have one of the best networks of free clinics in the country.  In 2012, North Carolina free clinics provided more than $211,204,000 in free health care services to 91,597 uninsured and underinsured patients in the state, adding up to more than 189,800 patient visits. 8,445 volunteer healthcare professionals and community volunteers made this awe-inspiring amount of service possible, donating almost 354,000 hours of service in one year alone. NC free clinics also arranged for more than $23,917,000 of free health care services provided by other health care entities within their communities. Most of these clinics have relatively few paid employees, while the majority of their staff are volunteer doctors, nurses, nurse practitioners, physician assistants, and other healthcare workers.  Some clinics are open full time; others are open in the evening; still others are open a select few days of the week.
In spite of these successes, free clinics in North Carolina are unfortunately only making a dent in the great mountain of need in this state and face difficult, increasingly complicated days ahead with the advent of healthcare reform. According to Jason Baisden, head of the North Carolina Association of Free Clinics, free clinics in the state saw about 100,000 patients in 2012 out of North Carolina’s 1.6 million uninsured residents.  While Baisden was quick to point out that these statistics do not count free care for low income patients provided by private doctors out of their own practices, you can infer from these numbers that there are a substantial number of residents in North Carolina who are not being seen by doctors at all. 
Earlier this year with the passage of Senate Bill 4, North Carolina declined to broaden Medicaid eligibility standards as provided for in the Affordable Care Act.  Senate Bill 4 was approved by the legislature and later signed by Governor Pat McCrory on March 6, 2013.  Adam Searing, head of the Health Access Coalition of the North Carolina Justice Center, indicates that the decision to turn down federal funding to expand Medicaid will leave half a million people without health care.  Searing stated that even if you combine all the work and resources of safety net health groups in the state, you are still only meeting 25% of the healthcare needs of uninsured and underinsured residents of this state. 
Perhaps more unsettling, funding is drying up for many free and reduced health clinics already open in the state. Triad Adult and Pediatric Medicine, Inc., in Greensboro, North Carolina made the sad announcement on July 31 that it will be closing its adult practice in Greensboro on August 30.  The closure of HealthServe Community Health Clinic, the adult practice of this clinic, will affect an estimated 20,000 patients, the majority of whom are uninsured. 
The Chief Executive Officer of Triad Adult and Pediatric Medicine, Inc., announced that, “[t]he ability to continue to provide care to more than 70% uninsured adult patient base at HealthServe is no longer financially feasible.”  HealthServe received $1 million each in donations from Guilford County and Cone Health in previous years.  Both organizations are no longer able to provide that support which HealthServe depends on to continue.  Clinic officials are worried their former patients will not be able to receive the medical attention they need or will go to emergency rooms,  worsening low income patients’ already precarious financial situation with soaring medical bills.
Misperceptions about the reach of the Affordable Care Act are also putting the future funding of these clinics in danger. Jason Baisden, head of the N.C. Association of Free Clinics, had this to say about the enactment of the Affordable Care Act: “One of the most common misperceptions about how the United States will look after the full implementation of the Affordable Care Act is that there will no longer be a need for our clinics to continue to provide charity care as a member of the safety net. In fact, many are surprised to hear that even after full implementation of the ACA, according to the Congressional Budget Office, there may be as many as 23 million people, including documented, undocumented, and those who are eligible for Medicaid but reside in states that are not going to expand this program, who are still without access to health insurance.
“As a result of this misperception, many free clinics have seen a decrease in funding and volunteerism. Free clinics are needed now, as increased demand for services has illustrated, and they will be needed well into the future."
The National Association of Free and Charitable Clinics made several important points about the enactment of the Affordable Care Act in order to clear misconceptions about its reach, specifically pointing out that the Act is not a universal health care system or Medicare for all.  While the Act will extend health care to more people, “free and charitable clinics will remain an important part of the country’s safety net, even after the implementation of the Affordable Care Act.” 
Only time will tell how these crucial components of our communities and lifelines to our state’s most needy will fare over the next few years. Despite their recent struggles, North Carolina’s free clinics are an excellent place to make a positive impact in the lives of those in your community. Whether an individual is investing time, talent or financial resources, free clinics provide a tremendous return on investment and community benefit. For more information on free clinics and how to get involved, please contact the NC Association of Free Clinics.
 Senate Bill 4 / S.L. 2013-5, “No N.C. Exchange/ No Medicaid Expansion.” http://www.ncga.state.nc.us/gascripts/BillLookUp/BillLookUp.pl?Session=2013
 http://www.nafcclinics.org/sites/default/files/Free%20anc%20Charitable%20Clinic%20Health%20Care%20Reform%20Talking%20Points.pdf ()
Posted by William B. Dickey on Mon. August 19, 2013 5:28 PM
Student Research, Through Our Eyes