Canaries in the Affordable Care Act Coal Mine


Community Health

Doctor and Patient at Oscar Romero Health Center

As the only nonprofit licensed to distribute Rx medications in all 50 states and conducting the largest charitable medicines program in the country with a network of roughly 40 percent of America’s nonprofit community health centers and charitable clinics, Direct Relief has a unique perspective on the gaps that exist in the healthcare safety net that exists in our country.

As the Affordable Care Act (ACA) implementation kicks off its critical phase this week, one way  to assess whether the intended benefits are being realized is to look at how these nonprofit safety-net facilities fare, since they have been serving people with limited means and no insurance – many of the same people intended to be covered by insurance under the ACA. And the facilities are expected to receive even more patients as events unfold.

Obvious, if perhaps obscured in the political conversation, is that health insurance itself is neither health care, a guarantee of access to health care, nor, fundamentally, good health. If facilities or providers do not accept a particular insurance plan for whatever reason – most likely because it is not considered to provide sufficient reimbursement for care – a newly insured person will not necessarily have more or any different access to health care services.

Nonprofit health centers and charitable clinics provide access to primary and preventive health services in a nondiscriminatory way. For all the many, intense disputes that continue to exist about the ACA, virtually none exists that more of these types of services are needed to improve health and reduce costs. If, as intended, broader insurance coverage means that health centers and charitable clinics receive payment for patients they have always cared for even when uninsured, the proven benefits of providing such access and care will be expanded for millions of people. Alternatively, if expanding insurance coverage becomes a balloon-squeezing exercise paid for by reducing reimbursements for care, the intended benefits of expanded access to care may be elusive.

So, as the ACA unfolds – differently in each state, with a big bet on insurance products and markets to expand access, improve results, and reduce costs – the status of these facilities, which serve more than 1 in 15 people in the United States today, will be a reasonable proxy to assess how things are going and whether the legislation’s broad purposes of better, more affordable, more accessible health care and better health are being advanced.

Direct Relief will be publishing its annual State of the Healthcare Safety Net report in the coming weeks to highlight this particular, important issue.

Charitable efforts such as those conducted by Direct Relief to help patients obtain medications they need but cannot afford and support locally run nonprofit clinics that serve vulnerable people typically exist for  people not served through either commercial activity or government programs. These efforts have been expanding rapidly in the past few years to fill very large needs otherwise unfilled. With high hopes that such needs will be lessened, Direct Relief will continue to support people that will likely continue to need help with support to the safety-net facilities that provide it.

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