September 12, 2013

Millions fall through Obamacare cracks

Even after the Affordable Care Act takes effect, demand for care in free clinics will remain high.

By SARAH KLIFF and LENA H. SUN The Washington Post

ARLINGTON, Va. - Every month, a hundred or so people crowd the lobby of the Arlington Free Clinic, clutching blue tickets to enter a health-care lottery. Uninsured and ailing, they hope to be among the two dozen who hit the jackpot and are given free care.

click image to enlarge

Retired nurse Jan Strucker is visibly upset after learning her chances of getting care at the Arlington Free Clinic are low. “This is shameful,” Strucker said. “And we’re only seven minutes from the White House.”

Washington Post photo by Michael S. Williamson

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Some might think the lottery's days are numbered, given that the insurance expansion under President Obama's health-care law will take effect in January.

But clinic officials say the lottery will remain, because demand for services is likely to be as high as ever.

"We will be business as usual," said Nancy Sanger Palleson, the clinic's executive director.

The Affordable Care Act, the most sweeping health-care program created in a half century, is expected to extend coverage to 25 million Americans over the next decade, according to the most recent government estimates.

But that will leave a projected 31 million people without insurance by 2023. Those left out include undocumented workers and poor people living in the 21 states that have declined to expand Medicaid under the statute, commonly called Obamacare.

"The law will cut the number of the uninsured in half," said Matthew Buettgens of the Urban Institute. "This is an important development, but it certainly isn't the definition of universal."

While hospitals and other providers gear up to handle an influx of Americans who will be newly insured as of Jan. 1, many of the nation's 1,000 free clinics, which cater to the uninsured and are financed mostly by private donations, are redoubling efforts to help those bypassed by the law.

The trend shows both the limits of the law and the way it is affecting nearly every corner of the health-care system, sometimes in little-noticed ways.

Some of the free clinics are planning to step up their focus on undocumented workers, who won't be permitted to buy insurance from the new online marketplaces and are expected to become a larger share of the uninsured. Other clinics, seeking to fill what they see as a major gap in the law, are considering offering free dental care.


Andre Sokol, a 59-year-old unemployed carpenter, is an example of someone who won't be helped by the law and will continue to rely on the Arlington clinic, which provides care to about 1,600 people.

He lost his health-care benefits when he left his job in the construction industry several years ago to care for his longtime girlfriend, who was diagnosed with ALS, or Lou Gehrig's disease, and his mother, who was battling dementia.

Two years ago, the women died within two months of each other. Sokol had no job, no income and no place to live.

In January, Sokol had quadruple bypass surgery at Virginia Hospital Center, which absorbed the costs. He didn't qualify for Medicaid because Virginia doesn't allow single men, no matter how poor, to be covered by it unless they're disabled. The state has one of the strictest eligibility standards in the country. That would change if the state expanded its program under the health law.

In addition, Sokol's income is too low to allow him to get federal subsidies to help pay for a private policy on the exchange. (The law assumed that people with incomes below 100 percent of the poverty level, or about $11,500, would be covered by Medicaid, but many states balked at enlarging their programs after the Supreme Court said the expansions were optional.)

After Sokol had surgery, the Arlington clinic agreed to take him as a patient as part of an agreement with Virginia Hospital Center. The arrangement is one way people can become patients at the clinic; others come in via the lottery or referrals from homeless and domestic-abuse shelters.

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