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

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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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"Most of our members would love to go out of business and close their doors if there was a program that ended uninsurance," said Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics. "But this isn't universal health care. We're not planning to see a dramatic decrease in our patients."

Busby said that many of the clinics she works with are facing an additional hurdle with the health law: convincing private donors that they will still play a crucial role after millions gain coverage.

"So many listen to the news and hear a 24-second sound bite that says everyone is getting coverage," she said. "The donors may think we don't need their funds."


The Arlington Free Clinic, which was founded in 1994, is staffed by doctors who volunteer when they aren't at their regular jobs. To be eligible for the clinic, individuals must be over 18, live in Arlington County and earn less than 200 percent of the poverty line, or about $23,000 for an individual. They must also have been in the United States for at least a year.

On a recent Tuesday, the line for the lottery went around the block. It included a wide range of patients, including young children and the middle-aged who spoke English, Spanish, Arabic, Mandarin and other languages.

"I need a doctor for a lot of things," said Ebtsam Ibrahim, a 46-year-old Egyptian woman and mother of four. She said she has had a toothache for two years but hasn't seen a dentist because of the cost. She was trying for the third time to win the lottery.

Nazmun Nahar, a 33-year-old mother of three, arrived cradling her 1-year-old daughter in her arms. She and her husband are Bangladeshi immigrants who became American citizens more than a decade ago.

Because Nahar's husband earns about $30,000 a year working at Subway, the family of five would probably qualify for generous subsidies to buy private health coverage under Obamacare. But like many of the lottery hopefuls, Nahar knew little about the law or how it would work.

"I just heard a little about it, but nobody explained it to me," she said.

Jan Strucker, 59, was one of the few people who was aware of the new insurance marketplaces. A retired nurse, she lives on about $20,000 a year in worker's compensation. She has serious health issues, and may soon need surgery. She thinks she would be eligible for subsidies under the law, but that means she needs to wait until October to enroll, and coverage won't kick in until January.

"This is ridiculous. This is shameful," Strucker said. "And we're only seven minutes from the White House."

By midmorning, the winning lottery tickets had been selected for 28 participants. A beaming Ibrahim, the Egyptian mother, was among the winners. A husband and wife from Russia also won one ticket that day. Each insisted that the other be the first to take advantage of the free health care, moving some clinic staff members to tears.

Lottery winners must go through an eligibility screening before their first appointment with a doctor, typically weeks later.

The other people who took part in the lottery, including Nahar and Strucker, went home empty-handed. Some will qualify for benefits under the health law. Others will probably return to the lottery, hoping to land a slot at the clinic.


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