Free Clinics Still Needed To Fill Health Care Gaps

Massachusetts has one of the highest rates of health insurance in the country, but that still leaves thousands of people who can’t afford the health care they need.

Dr. Sara Tischer is examining a 30 year-old named Kevin, who has come to this East Longmeadow clinic for a stubborn cold or flu or something that won’t go away.

‘When did all that start?’,” she asks, as she listens to his cough.

This is the first time Kevin has met Dr. Tischer — who’s volunteering here as part of her medical residency program. So she has to quickly get up to speed.

“Do you have a cough normally? ” she asks.  “Any fevers, chills?”

After ruling out pneumonia, Tischer finds Kevin an asthma inhaler from their backroom stock of medications. When he leaves the office, there’s no mention of a bill, a copay, or of health insurance at all. Which is good, because he doesn’t have any.

“I’m in between jobs,” he says, “and it’s the only way I can get anything without losing every penny that I have left.”

By which he means, coming here, to Pioneer Valley Free Health Services — one of about 25 free clinics statewide. It’s open two hours a week, every Wednesday evening, in a short brick building that doubles as a gynecologist’s office by day. Springfield doctor Andrew Balder is medical director for this clinic of last-resort.

“We’re plugging these holes that still exist,” Balder says.  “And there are always these holes out there.”

Balder — who’s lanky and graying — has always worked in underserved communities. He’s been with the Pioneer Valley clinic since shortly after it opened — 18 years ago. Back then, the all-volunteer clinic operated in the basement of an East Longmeadow church.

“We started seeing folks from 30 to 40 miles around,” he says. “Out to ware, out to Westfield, you name it. They started coming in the door.”

That was before Massachusetts passed its 2006 health law, which was designed to get almost everyone on insurance — either from employers, through a state subsidized program, or with a private plan. After the law went into effect, Balder says demand for the clinic’s free services was cut in half.

“But it didn’t go away,” he says. “There’s still people in gaps between jobs, between insurance, new to the country, new to the state.”

They also care for undocumented workers who don’t qualify for state sponsored insurance, or people who can’t afford the health plan offered by their employer. All those cases contribute to the 3 or 4 percent of the state population who remain uninsured even after Massachusetts’ health reform.

“Nobody expected health reform to lead to universal coverage,” says Brian Rosman, with the consumer group Health Care for All, which helped pass the health reform law. Rosman says the continued need for free clinics is not a sign that the law is not working.

“We in Massachusetts are way ahead of the rest of the country,” says Rosman, “but we have a complicated system, there are gaps in coverage, so there’s still need for clinics to pick up the gaps.”

Yet Dr. Balder says a free clinic is not equipped to pick up ALL the gaps.

“This is not a great place if you have complex, chronic disease,” Balder says. “If you get sick on Friday, we’re not here until Wednesday. You can’t talk to us. We are not really set up to be your medical home.”

And some cases require expertise beyond the regular cadre of primary care doctors.

For example, on this day, a five year old boy has come in with his mother Eleatha for a rash that appeared months ago….and when the first doctor can’t identify it, he invites the others to take a look.

“you stumped us!” says Dr. Tischer.

They eventually refer the family to a dermatologist — going off a list of specialists who offer free appointments. Eleatha — who says she applied for state-subsidized insurance but hasn’t heard back — is relieved to have options.

“They volunteer their time, so they’re really passionate and care about their patients,” she says.

The charity care extends beyond the doctors to nurses, pharmacologists, midwives, and non-medical staff. The Massachusetts Medical Society pays the malpractice insurance. And while the state does fund some free health care, it’s mostly distributed through community health centers and hospitals, so the free clinic depends on donations for its $5,000 dollar annual budget. But Balder says the longterm solution is for more people to graduate from the free clinic. Since Obamacare went into effect, he says, that’s starting to happen… in fact, the last few weeks have been quiet — about 5 or 6 patients on this Wednesday compared to 20 on a busy night.

“We don’t know if that’s because of the weather or insurance status,” Balder says. “We have a couple of anecdotes of people getting insured now that weren’t before..”

But many people, he says, will never find a place in the mainstream healthcare system, so until the number of uninsured goes down to zero, the Pioneer Valley Free Health Services will continue to put out its shingle for two hours every week.