Alex Ming figures he’d be dead of a heart ailment if it weren’t for HealthReach Community Clinic.
The free medical clinic on Statesville Avenue serves Iredell County residents whose household incomes are 250 percent of the federal poverty level or less and have no health insurance or just catastrophic coverage.
“This clinic right here, if it wasn’t for them, I’d probably die,” Ming, a 47-year-old tow truck driver with no health insurance, said during a recent checkup with a family nurse practitioner at the clinic. “These people are a godsend for me.”
Ming said he earns $400 a week and can’t afford insurance under the Affordable Care Act for him and his wife, Linda, who is disabled. They’ve struggled to pay for food, utilities and other bills and dropped their Internet service.
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“I pay my taxes. I work. But I can’t afford Obamacare,” Alex Ming said.
“We have no health care, nothing,” his wife said.
The perception that most people are covered because of the ACA has led to a 70 percent drop in unrestricted individual gifts to HealthReach since passage of the act in 2010, said the Rev. Steve Sellers, vice president of HealthReach’s volunteer board of directors.
The couple qualifies for a subsidy under Obamacare but still can’t afford the health care cost.
Like many other free clinics for the working poor, HealthReach accepts no government money, no Medicaid patients. It relies instead on individual cash donations, grants and donated services.
But the perception that most people are covered because of the ACA has led to a 70 percent drop in unrestricted individual gifts to HealthReach since passage of the act in 2010, said the Rev. Steve Sellers, vice president of HealthReach’s volunteer board of directors.
Meanwhile, the clinic continues to see about 1,000 patients a year with over 4,000 office visits, and fills 15,0000 prescriptions.
“We’ve been fighting that perception for three years,” said Amy Carr, executive director of Matthews Free Medical Clinic. Its volunteers have been speaking more than ever to community organizations for donations to maintain its $220,000 budget.
Statewide, a million people have no coverage, said Lou Hill, executive director of the N.C. Association of Free Clinics. Its 70 member clinics serve 87,000 patients a year.
“ACA is a complicated piece of legislation, and not all people are covered under it,” she said.
But individual contributions to free clinics in the state declined 33 percent between 2011 and 2014, and the number of volunteers by 25 percent, she said, again because of the perception that most everyone is covered.
‘Medicaid gap’ squeezes
The Affordable Care Act, passed by Congress, requires most U.S. residents to buy health insurance. To make the coverage affordable, it provides tax credits to reduce premiums for those whose incomes are under certain levels.
But about 600,000 North Carolina residents – some of the poorest of the poor – remain uninsured because they fall into the so-called “Medicaid gap.”
That is because North Carolina is one of about 20 states that rejected the law’s option to expand Medicaid to cover more low-income and disabled citizens.
Those in the gap find themselves in a Catch 22. Their household incomes are too high to qualify for the state’s current Medicaid program. And although they’re allowed to buy private insurance through the federal online exchange, they generally can’t afford it because their incomes aren’t high enough to qualify for the federal tax credits.
Medicaid expansion would have provided insurance for these residents whose household incomes are less than 138 percent of the federal poverty level, or $27,310 for a family of three.
Authors of the ACA assumed people in that income bracket wouldn’t need tax credits because they would be covered by the Medicaid expansion.
Drop in donations
Because of the drop in donations, HealthReach was forced to cut its budget by 40 percent – it’s now at about $200,000 – although none of the cuts were to medical care, Sellers said.
The nonprofit trimmed the number of days it operates each week from five to three and eliminated three full-time positions, including that of its executive director, a fundraiser and a medical assistant.
The positions were all non-medical provider jobs and did not impact care, Sellers said. Two part-time positions also were cut, including that of a social worker.
While trimming the number of days, the clinic added more patient slots on the days it’s open and is seeing the same number of patients as before, Sellers said. “We’re running a leaner shop, as it were,” he said.
Still, “these are not decisions that any nonprofit likes to make, but based on our current financial situation, we’ve had to act quickly,” said Kristina Hill, HealthReach board chairperson.
The clinic raises about $104,000 annually through grants and individual donations and is in a year-end campaign that hopes to raise $25,000 to $30,000.
“Our goal is to continue to serve those with medical needs, as there is not another free clinic in our area,” Hill said. “We just need the community’s support to continue.”