On the last Wednesday in January, the RotaCare Tacoma free clinic in Washington state put away the chairs in the university janitor’s lunchroom where it had made its home and closed its doors for the last time.
The clinic, served by volunteer physicians and registered nurses, had carried 150 patients at any given time to serve the uninsured population in this city of about 200,000. But after Obamacare took full effect in January, and this clinic completed its drive to enroll all of its patients in coverage, it didn’t have anyone left to serve.
So they shut down at the end of January, the first month that health coverage under Obamacare kicked in. The people who worked there don’t seem too torn up about it.
“It happened very quickly. We had to start telling our providers not to come because we didn’t have enough patients,” Mary Hoagland-Scher, a Tacoma family practitioner who served as the clinic’s medical director, told TPM. “It just dried up. Poof.”
That makes RotaCare Tacoma an unusual case, but not an entirely unique one. Free clinic directors in Iowa and Ohio said they haven’t seen anything like it on a systematic level. But there is the story of a free clinic in Medina, Ark., which closed in April after seeing its number dwindle from 300 to 80 to three as people obtained coverage through Obamacare in the first three months of 2014.
“Our services won’t be needed anymore,” the director told a local newspaper.
But at RotaCare Tacoma, closure had been the goal ever since the Supreme Court upheld the law in June 2012, Janet Runbeck, a registered nurse who also oversaw the clinic, told TPM.
The clinic opened in 2009 specifically designed to serve people with chronic conditions like hypertension and diabetes. It had a staff of eight volunteers, all registered nurses or doctors, and worked with as many as 150 patients at any given time. About 15 of those patients would come every Wednesday night when the clinic was open, Runbeck said.
They would serve patients for up to a year or until they got insurance. After opening in the Sunday School classroom of a local church, the clinic moved to the janitor’s lunchroom at Pacific Lutheran University just outside Tacoma. They would push all the tables to the back of the room to set up an impromptu waiting room. All the chairs faced the same way, and every week, somebody brought a different Disney movie for patients to watch while they waited, Runbeck said.
They would set up four exam rooms using pipe and drapes in a neighboring conference room, where the patients would be taken after spending 10 to 15 minutes with a nurse, who checked their blood pressure and other vital signs. Doctors would then spend as much as one hour with a patient, Runbeck said — a sharp contrast to the time limits sometimes placed by private insurance.
It was a good system, Runbeck said, but it was limited. The clinic stuck to patients with hypertension and diabetes, and didn’t have the resources to treat those with other chronic diseases like cancer, Parkinson’s or HIV. Hoagland-Scher, the medical director, recalled some patients coming in with asthma who they were unable to help.
So when they knew Obamacare would remain after the 2012 Supreme Court decision, Runbeck made a pledge to sign up all of their patients, get them new medical homes at full-time practices, and then close down.
“These other free clinics are trying to hang on,” Runbeck said, “and I say, ‘Why? Why not get social workers in there to connect people to real benefits?'”
If they didn’t shutter, she explained, “people would keep coming to us forever, defeating the whole purpose of the ACA. Chronic disease should have a medical home, anyway.”
So starting in October, as Obamacare’s enrollment launched, the clinic had social workers authorized to help people enroll come and assist their patients in signing up. By January, almost every one of their roughly 150 charges had either enrolled through Obamacare or gotten a job with coverage. A few undocumented immigrants were transferred to another program run by the local medical society. They stocked up their other patients with three months’ worth of their prescribed medications to ensure they would be properly cared for until they could schedule an appointment with their new doctor.
Runbeck recalled one middle-aged woman, a type I diabetic, who had gotten enrolled in expanded Medicaid, one of 285,000 Washingtonians to do so. At the same time, she was finishing up a course at a community college job training program. The last time she saw her, Runbeck said, the woman was pledging to volunteer at a free clinic as soon as she could.
“People were crying because they got insurance. It worked,” Runbeck said. “Chronic disease is what kills most people. It needs to be managed in medical homes, and free clinics are not set up to manage the whole patient.”
While Runbeck and company tout their experience under Obamacare as a success, others in the free-clinic community stress that the need is still strong, particularly in states without expanded Medicaid and areas with a large number of undocumented immigrants who can’t get coverage under the law. That is not going away anytime soon.
“There is still a big need for free clinics,” Christine Lindquist, the executive director of the Washington Healthcare Access Alliance, told TPM. “There are so many people who feel like, ‘Oh, we don’t need to support these efforts anymore,’ and it’s just not true.”
But emerging stories like those in Arkansas and Washington suggest that tangible effects of Obamacare’s coverage expansion, for the formerly uninsured and those who serve them, are starting to be felt.
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