Roosevelt Institute | Cornell University

Identity Crisis: Where Do Free Clinics Fit Into the Affordable Care Act?

By Angelica CulloPublished September 21, 2015

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Should free clinics accept patients that already have insurance? As enrollment through the Affordable Care Act continues to expand, and free clinic services continue to be in high demand, these clinics face tough decisions about how to deliver care.

Despite The Affordable Care Act's (ACA)  expansion of Medicaid (government funded health insurance) to an additional 16 million people, 20 million people still don't have insurance in the United States. This 20 million is made of mostly of people who have an income below poverty level, but not low enough to qualify for public health insurance. Despite this increase in the number of Americans with coverage, these individuals don't necessarily have access to more services, nor do these services necessarily cost less for the patient. Many plans under the ACA cover a limited number of physician services or have high copayments. As a result, many with insurance are increasingly looking to free clinics to provide gaps in care to these individuals  (often referred to as the "underinsured". 

The demand for free clinic services continues to be greater than can be met by volunteer capacity. Nationwide free clinics are confronted with decisions about who to treat. Should they treat individuals who are recently covered under Medicaid and are seeking services to fill gaps in their coverage? Or should they prioritize individuals that are completely uninsured?

While most free clinics provide care to anyone who is uninsured, since the provisions of the ACA have taken effect, at their own discretion some clinics are agreeing to see individuals who have insurance, but who are seeking services that are not covered or they are not able to afford under their existing plan. These clinics reason that a person should be considered uninsured, regardless of whether or not they have Medicaid or are filling in a gap in their existing health care coverage. If  the clinic offers a service that someone does not have access to, it should be provided. Many clinics also decide who they will serve based on the patient's income. If they earn no more than 200% of the federal poverty level, the clinic will generally serve them.

But could this lead to abuse of the system? Some claim that if an individual has insurance, they should not use resources that would take away from those who have none at all. This dilemma presents both moral and economic decisions. In the end, whoever the free clinics decide to see, the guidelines should be clear, consistent and uniform from clinic to clinic.