Community health centers seeing more underinsured patients

At community clinics, underinsured replace uninsured

By Mark Zdechlik
MPR News, September 16, 2015

A few years ago, community health clinics routinely offered care to people with no health insurance. Today, offering care to people who have insurance — but still can't afford care — is becoming more common.

At the Sawtooth Mountain Clinic in Grand Marais, Minn., more people coming through the doors have a health plan, as required under the Affordable Care Act. But the plans with the lowest monthly premiums tend to have high deductibles.

Clinic CEO Rita Plourde said that for many clients, the problem now is being underinsured. They have health insurance but cannot afford the out-of-pocket costs.

In Coon Rapids, Nucleus Clinic gets some referrals from conventional clinics when patients are having difficulty with out-of-pocket expenses. Becky Fink, who runs the community reproductive health clinic, said that many patients with a high deductible health plan find it less expensive to bypass the insurance and pay cash.

Fink expects the growing demand for subsidized clinic services from people enrolled in health plans will continue despite the signature promise of Obamacare.

It's frustrating to see insured people who can't afford to pay for health care, Fink said. People need to know that the Affordable Care Act is pushing more people toward community health centers, she said, not decreasing the need for them.



By Don McCanne, M.D.

As we celebrate the successes of the Affordable Care Act, it is sobering to realize that the increasing prevalence of underinsurance is leaving many patients dependent on community health centers, much as they were before, when they were uninsured.

It is fortunate that our legislators, led by Sen. Bernie Sanders, recognized that there would still be a great need for community health centers and insisted on authorizing funding for these centers.

But wouldn’t it be even better if everyone had comprehensive first dollar coverage? The clinics would no longer be geared to take care of mostly low-income patients but rather would be transformed into centers that could appeal to all of us, including specialists who would then welcome referrals from these centers.

All we need to do is to enact a well-designed single payer national health program, and the improvements would automatically follow.