The impact of the repeal of Affordable Care Act, also known as Obamacare, and its possible replacement could significantly impact a group of clinics in St. Louis and St. Charles counties that provide free medical care to patients without health insurance. Or it might not. They’re hoping for the latter, but only time will tell.
If Obamacare disappears or changes occur, as the Republican Congress and President Donald Trump have promised, could those clinics see their telephones ringing from people looking for other health care options?
Officials with the three clinics – Volunteers in Medicine, with one in St. Charles and another in Manchester, and the Crossroads Clinic Volunteers in Medicine in Lake Saint Louis – say they have no idea – at least, not yet.
Right now, the clinics’ tight eligibility requirements might protect them. They only take patients, age 18 to 64, who are not covered by Medicare, Medicaid or private insurance and who have an income of 200 percent of the federal poverty level. For a single individual, the eligible income cannot exceed about $23,000.
“We’ve been around for 20 years. We lived through a long period without Obamacare and Obamacare didn’t change our model very much,” said Dr. Silippo Ferrigni, medical director for the St. Charles clinic. “We had a six-week waiting period at the depths of the recession in 2007 and 2008. Our waiting period now is between two and three weeks so we might go back to six weeks.”
Cheryl Moellenhoff, the clinical director of the Crossroad Clinic, said, “I just don’t know what will happen.” But she said the clinic would try to do what is needed. “If there is a sudden influx then we will work our best to increase our hours, open another day or whatever we need to do to take care of them,” she said. If new patients qualify, they will make an appointment at the clinic, she said.
Ferrigni said major issues that could trigger calls could occur if Obamacare is revoked and not replaced. Those issues include the impact on young people now being carried on their parents’ health insurance, people with pre-existing health conditions and lifetime caps on health coverage. “Those may have a huge impact much more than the folks losing their [insurance] exchange,” he said.
Suea Waser, clinical director at Volunteers in Medicine-West County, agreed that no one knows the possible impact of health insurance changes, but added, “We do anticipate an influx of patients; we are a free clinic.”
Waser said the clinic now is open three days a week – Sunday, Thursday and Tuesday. “We don’t know [if] that’s enough or not, it depends how many patients we get,” she said. “We’ll try to accommodate them as much as possible.”
Moellenhoff said she didn’t see a big shift in patients when Obamacare became a reality – about 150 new patients in 2015 and about 140 new patients last year. But, Moellenhoff and other clinic volunteers and physicians say that free clinics are a necessity, because the cost of health insurance and deductibles could still be out of reach for many people, even though they are employed.
Each clinic is an independent, nonprofit organization responsible for its own fundraising, governance and finances. They are open a few days a week with limited hours and manned largely by volunteer physicians, nurses and staff.
The clinic’s patient loads can vary from 600 to 1,000 people or more annually, largely dependent on the availability of medical personnel and available funding.
They stem from a concept going back to 1984 when the first Volunteers in Medicine clinic opened in Hilton Head, South Carolina. Additional clinics followed. The St. Charles clinic, at 1039 Duchesne Road, opened in 1994 and serves patients largely from St. Charles and Lincoln counties.
Dr. Maimuna Baig opened the volunteer clinic in Lake Saint Louis in 2010 with help from SSM Health St. Joseph Hospital in Lake Saint Louis. The clinic, at 10714 Veterans Memorial Parkway, has since changed its name to Crossroads Clinic and serves patients from St. Charles, Lincoln, Warren and Montgomery counties. The Manchester clinic, at 14595 Manchester Road, was opened in 2011 by Baig and her husband, Sajjad Baig, and provides both primary and mental health care services.
The clinics cater to the “working poor” who often have to sacrifice health care to pay rent or buy food. “Our clientele are the same people, it’s the 7-11 clerk, it’s the laid off worker, typically with less skilled jobs,” Ferrigni said.
Providing patients with basic health care keeps them away from emergency rooms. “That’s expensive to the hospital provider and it’s episodic care, it’s not ongoing care management,” Moellenhoff said. People who are not very sick and run out of medications often show up in emergency rooms, she said. “That’s what I call episodic care – fix the immediate problem but not the long-term issue which makes them [patients] healthier.”
One hope is that Republicans will replace Obamacare. But Moellenhoff said there is really no way to tell what a potential replacement for Obamacare may look like.
“If the monthly premium is still going to be what it is without any subsidy there will be fewer people able to take it,” she said. “If it’s a higher premium, few people may be able to take it What I’m seeing now with the marginally poor is that they went out and got an insurance plan, but the deductible is so high they aren’t getting care, they aren’t getting anything.”
The clinics don’t have the ability to do much more to expand their services, clinic officials say. “Everything is at the maximum to what we can do,” Ferrigni said.
The clinics run tight ships, but they do have expenses, such as rent and providing drugs for patients. To help lower costs, they work closely with major health care providers, such as SSM Health and BJC HealthCare, who provide testing and services. The Lake Saint Louis clinic is financially sustainable with a budget of about $80,000 a year, Moellenhoff said. Anita Hockett, clinical director at the St. Charles clinic, said it had a $170,000 budget last year and provided more than $3 million worth of patient services.
“Our main constraint is in trying to find physicians who will volunteer to serve,” Moellenhoff said – a comment echoed by officials from the other clinics. “Nurse practitioners are fine, but for any couple of practitioners you have to have a doctor and that’s been our limiting factor.”
Mollenhoff said she understands the goal of Obamacare but Ferrigni is hoping for something new.
“Yes, it [Obamacare] gives them [patients] access to primary care as long as they can pay for it. That’s the whole goal,” Moellenhoff said. “Politically, Democrat or Republican, I’m a health care provider so I’m just concerned about that they [patients] have access. The key component is access.
“I think that’s what the president [Obama] had in mind when he developed the plan for them, and hopefully that’s what the current president has in mind – how we [create] access, because without access, people would choose the ER for their care.”
“It’s a risk and we’ll see,” Ferrigni said. “My hope is that campaign promises are kept, it’s going to be repealed and replaced and better than what it was, right? That’s the promise.”