The Ebola crisis has revealed severe deficiencies in how the American health care system works, experts say.
By Julia Burke
An estimated 700 people attended a free clinic at Alliant Energy Center on Saturday in Madison, Wisconsin. Offered by the National Association of Free and Charitable Clinics, this opportunity for uninsured or underinsured people to get checkups, treatment, and care was one of several that have been held around the country since 2009.
From 10 a.m. to 5 p.m. on Saturday, August 9, the Alliant Center was filled with exam rooms, 100 doctors, and several hundred nurses. Patients waited for physical exams, blood and urine tests, free medications, and advice on options for regular free clinics around Madison. Some people who attended the clinic had appointments. Others walked in to get medications refilled, undergo checkups, and address medical concerns. Some arrived with emergency conditions and were sent to local hospitals.
The thirteen previous clinics have largely been held in major cities, including Houston, Dallas, and New Orleans, but with over 200,000 Wisconsin residents still uninsured and attempting to navigate the Affordable Care Act (ACA), the need for the free clinic in Madison is clear.
According to a July 2014 news bulletin from the University of Wisconsin Public Health Institute, Wisconsin is one of the lowest-ranking states in both state and federal public health funding per capita: it ranks 46th in U.S. Centers for Disease Control and Prevention (CDC) funding; 48th in Health Resources and Services Administration (HRSA) funding; and 46th in state public health funding.
“I don’t live far away from here so I thought I’d come volunteer as well,” says health care provider Cindy Munson, whose family members have been Charitable Clinic captains with the NAFCC for several years. “There are 50,000 people just in Madison alone that are uninsured, even with Medicaid and [the ACA]. It’s unfortunate that people have to have their health care in a convention center once a year, but it’s wonderful to have it at all.”
“This event is really important because it’s a great venue to be able to provide individuals here in Madison and the surrounding area with a way to know about what resources are available, and to provide them access to care,” Dr. Bobby Kapur, residency program director and associate professor of Medicine and Pediatrics at the Baylor College of Medicine in Houston, explains. “We’re excited about the ACA and what that’s going to provide for health care plans. But the reality is that there are a lot of individuals who don’t have information about those resources yet, who haven’t been able to sign up yet, and there’s a lot of people we know of in this region––tens of thousands––who still don’t have access to health care.”
Governor Scott Walker rejected a Medicaid expansion in February 2013, turning down $119 million in federal money, and reduced eligibility limits earlier this year, causing more than 62,000 Wisconsin residents to lose coverage. Walker’s alternative BadgerCare plan has cost more than expected, his administration admitted last month––to the tune of $93 million that must come from the state budget.
Kapur says he sees three major challenges in national health care now that the ACA has been passed. “One is getting people enrolled; we still have 50 million people uninsured in this country,” he says. “It’ll take maybe a decade for the implementation of that. Secondly, we don’t have enough primary care providers to fill that void. If you put 50 million people into the health care system and we don’t have enough providers in the country to see all those patients, you have clinics with wait lists that are months long.”
Finally, Kapur says, “There are a lot of undocumented individuals that still need access to care,” not just in the border states but, increasingly, across the country. “Whether the person is a citizen or not, documented or undocumented, when you don’t provide them care, the result is that it turns into a life-threatening emergency,” he explains. “Patients come in with a stroke, a massive heart attack, a diabetic crisis. So then they’re going to inundate our emergency departments, and someone still has to foot that bill.”
One patient in the waiting area, who asked to be identified as Deana, is a diabetic who wants to stay on top of her illness and avoid complications. She’s been uninsured since the end of last year, when her husband went from full to part-time employment and lost coverage through his employer. “I looked at the Affordable Care Act options, but I missed the open enrollment period, and I wasn’t sure I could still [enroll],” she says.
She hopes to get advice and assistance with ACA enrollment. “I’m curious about it; I wanted to talk to somebody versus just trying to do it by myself.
“It’s been hard,” she adds. “When we did have insurance through my husband’s employer, the employer wasn’t complying with the law; I felt like we were paying so much more than we should have and it didn’t cover a lot of stuff. So I’m not too confident at this point. It’s a Catch-22. Do you take [an insurance plan] and hope you get the coverage you need, or do you just wing it and hope nothing happens?”