Obamacare steps up for patients at free clinic

April 20, 2014 

For five years, the Union Gospel Mission in Olympia ran a completely free clinic for uninsured poor with chronic medical problems such as hypertension or diabetes. Patients were not chronically sick enough to qualify for state Medicaid or old enough to qualify for Medicare.

Several providers volunteered an evening or half-day here and there throughout the month. A medical assistant was the only full-time paid staff.

The clinic was an effective outreach in many ways. People were able to work because they were not sick from uncontrolled diabetes or asthma. We used the inexpensive medication list from Walmart and other pharmacies, as well as the drug companies’ prescription drug assistance programs. There was a small budget from the mission for those times when we just had to supply medications ourselves or order simple labs and other studies.

When Obamacare was debated, I was excited. Seeing these patients, I knew that what we were doing was helpful but not as useful as a fully funded regular clinic — one where medications were paid by insurance and where patients could get necessary testing, treatments, and referrals, from CT scans to tumor biopsy.

I followed the debates and discussions and was hopeful with the passage in 2010 of the Patient Protection and Affordable Care Act — otherwise known as the ACA or Obamacare.

But 2010 passed into 2011, and 2012, and 2013. And still no coverage for our patients. Like many, I had hoped for a quick solution that did not come.

In fact, through all of this time, we gathered more patients in need. As the state budgets were affected by the recession, Medicaid was further limited, adding to our patient load. And job losses meant more people without insurance.

In late 2013, the clinic doctors and administrators met to decide what to do with January 2014 coming, when the section of Obamacare that applied to our patients was supposed to finally get them insurance. We decided to continue as we had been and see whether the patients would still need us.

We thought that even if the ACA components expanding Medicaid became effective in January, it may take up to a year to get everyone registered. In the meantime, we participated with the Obamacare signup through the Washington state programs, and registered people, struggling as others did with the difficult website.

In January, we started canceling clinic times. Patients were not showing up. They had obtained insurance and were seeing their new providers.

By the end of January, all of our patients had basically moved on. Despite negative news, despite the difficult website, despite the negativity, our patients were able to get Medicaid coverage.

So at the end of January, we had some goodbye cake and called it quits. We were very glad for the patients, though sad to see them go and sad to say goodbye to our friends and workers.

Thank you to all of those who worked very hard to get this insurance coverage passed to help the poor in our communities. I am not saying it is perfect. In fact, the next job is to cut the cost of our national health care expenditure.

But this group of patients now can actually get back to work, get back to health, with much less restriction, due to the Affordable Care Act.

Paul Bunge, M.D., is an internal medicine physician from Olympia who has volunteered locally and internationally.

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