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Low-Cost Clinics Face Challenges Brought On By Obamacare


Low-cost clinics are a lifesaver for people who do not have health insurance. Most of those clinics do not take insurance; the patients pay with cash or credit cards. But some have had to change the way they do business as more people get medical coverage through the Affordable Care Act. In Minneapolis, one clinic has closed its doors after 42 years because of a big drop in patients, and that has left thousands of remaining patients without basic medical care. From Minnesota Public Radio, Matt Sepic reports.

MATT SEPIC, BYLINE: Back in 2008, Darla Evanosky had what she thought was a serious heart problem. A restaurant server, Evanosky didn't have health insurance, but because of the Neighborhood Involvement Program, or NIP Clinic in Minneapolis, she says getting an appointment with a doctor was easy.

DARLA EVANOSKY: It was really cool because I was actually able to see a heart specialist, and he said, you have a really routine heart murmur. It's not a big deal. I wouldn't worry about it.

SEPIC: Evanosky, now 34 and still healthy, says her income bottomed out during the recession, but she was still able to pay for the appointment because of the clinic's sliding fee scale. She soon hopes to find an affordable health plan through MNSure - Minnesota's State Exchange, but she couldn't when it started because of early website glitches. Today the NIP Clinic is no longer an option for Evanosky and about 3,000 others here.

CEO Patsy Bartley says revenue dropped by nearly a third since January when coverage kicked in for people who bought MNSure plans. Others signed up for Medicaid after Minnesota expanded eligibility to more low-income adults. With many patients going to other providers that accept insurance, Bartley says it became impossible to balance the books.

PATSY BARTLEY: That's a huge drop for us to be able to continue to provide our infrastructure to do this work.

SEPIC: Some charitable clinics - including eight in West Virginia - have changed their business models and now accept Medicaid payments, but here in Minneapolis, Bartley says installing the required computer systems and hiring staff to deal with complex insurance billing and electronic medical records was cost prohibitive. While there weren't enough patients to keep the lights on, clinic co-director Janet Tolzman says many kept coming until the doors closed late last month. Among them, she says, were newly insured people unable to afford deductibles and co-pays.

JANET TOLZMAN: That was their trade-off for an affordable monthly payment, but then what happens when you do need to see a provider? All of a sudden, they're having monthly payments plus having to figure out how to do the whole out-of-pocket expenses.

SEPIC: Rachel Garfield, a researcher at the Kaiser Family Foundation, says another reason people with insurance continue to visit low-cost providers is convenience - not a small consideration if you have to take multiple cross-town buses to see a doctor.

RACHEL GARFIELD: The clinics are located in places where they live, and perhaps they were seeing their doctor there even before they had coverage.

SEPIC: Garfield says many charitable clinics are in a sort of catch 22 situation because of the Affordable Care Act. Revenue is down now that more people have insurance, but the clinics still need to stay open for the uninsured and underinsured. While many providers are facing challenges, Nicole Lamoureux with the National Association of Free and Charitable Clinics says demand for low-cost care remains high even in states friendly to Obamacare.

NICOLE LAMOUREUX: In Minnesota even after the full implementation of the Affordable Care Act, there will be 243,000 people who will be left without access to health insurance. And that's a great number of people, and that's where you will see that the free and charitable clinics, as well as other members of the safety net, will continue to provide care.

SEPIC: Lamoureux says the need for charitable clinics is in fact growing across the country - though mainly in the states, unlike Minnesota, that have so far not embraced the Affordable Care Act. For NPR News, I'm Matt Sepic in Minneapolis. Transcript provided by NPR, Copyright NPR.

Matt Sepic