PEOPLE HELPING PEOPLE: The future of free and charity healthcare

Greg Lang

Greg Lang

By Greg Lang

We’ve heard much in the news in recent days about the Affordable Care Act (ACA), known to many as ObamaCare. No matter what you think about the ACA, one cannot deny it is changing the delivery of healthcare services as we once knew it. I am often asked if the ACA make free and charitable medical clinics a thing of the past. My answer is a resounding “No.”

There is no doubt some employers will drop health care coverage entirely rather than comply with the Affordable Care Act (ACA) and the health plan coverage mandate. The Congressional Budget Office (CBO) has estimated approximately 7 percent of U.S. workers could lose employer-sponsored health coverage by 2019. The CBO also predicts 20 million people will lose health insurance in 2014 as low-profit employers drop coverage, forcing employees into exchanges which, based on recent events, very likely will not be ready when planned. Even after those who can enroll in Medicaid do so and others enter healthcare exchanges, CBO predicts 30 million people will remain uninsured.

The decision to drop health coverage over the next few years is expected to be more significant in lower-wage industries such as hotel, retail, and restaurant industries. We’ve heard of employers are decreasing hours to less than 28 per week to avoid having to provide health insurance or pay a penalty for not doing so; this practice affects most often the low skill, low wage earner. It is believed by many that poverty will soon be less a factor in being uninsured, surpassed by being employed by small employers and employers of low margin industries.

Recent census data reveals 1.9 million people, roughly 20 percent of all Georgians, are uninsured. Atlanta is where nearly one in four people of working age are without health insurance; the city ranked fifth in the nation for its number of uninsured residents. In Gwinnett County, population 815,000, nearly 11 percent are living below the poverty level, and 26.5 percent of its working population is without health insurance. Last year 43.8% of unemployed workers in the U.S. did not have health insurance, while in Georgia, 53.6 percent of the unemployed were uninsured.

In addition to increased poverty, unemployment and rates of being uninsured, other adverse forces are at work in the healthcare marketplace. There are increasingly less primary care options available for all healthcare consumers because fewer physicians are devoting their career to the primary care field. The United States faces a shortage of 90,000 primary care doctors by 2020 and 130,000 by 2025, says the Association of American Medical Colleges. Georgia’s population has been increasing faster than its supply of primary care doctors.

The state may never again have an adequate supply of physicians, according to a report by the Center for Workforce Studies. The report predicts Georgia will rank last in the United States in physicians per capita by 2020. It is quite possible the patient demographic free and charitable medical clinics serve will change to eventually include non-minority groups and those not living in poverty simply because fewer primary care options are available to the traditional paying healthcare consumer.

Put simply, free and charitable medical clinics do not expect a decrease in demand for our services to result from ACA; instead, we predict an increase in demand. In the short term, our patient population will consist of low wage earners, part-time employees, the poorest of the poor who have decided not to buy individual insurance or who are exempt from the requirement, and undocumented residents. In the long-term, our patient population may very well include the mainstream primary health consumer. Rather than worry about our missions becoming obsolete, we are considering how we will respond to fill the gaps in the healthcare delivery system that are sure to only widen in the coming years.

Greg Lang is executive director of The Good Samaritan Health Center of Gwinnett, a non-profit organization serving the primary care needs of uninsured citizens of Gwinnett and surrounding areas.

People Helping People is a publication of the Gwinnett Coalition for Health & Human Services. For more information contact Ellen Gerstein - ellen@gwinnettcoalition.org or at 770-995-3339.