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Everything comes with a cost: the perilous (and unnecessary) fate of the Portland Free Clinic

June 4, 2014 by

Despite the historic opportunity offered by the federal funds available to expand Medicaid to cover Maine’s uninsured, millions of dollars earmarked for our state have been lost – more than $143 million since January 1 -repudiated in a din of partisan politics.  The governor vetoed majority votes in favor of Medicaid expansion five times.  But decisions have consequences – and one of the consequences might be the future of the Portland Free Clinic.

Operating on a shoestring annual budget of $110,000 for 21 years, the Portland Free Clinic has served the uninsured at no cost.  Medical providers donate more than 2,000 hours of their time each year.  The clinic serves the working poor.  Free Clinic patients earn too much to qualify for the existing Medicaid program, but too little to afford health insurance or participate in the Affordable Care Act Marketplace.   Now the clinic’s existence is threatened.  The unmet need for healthcare is outstripping the clinic’s ability to offer it.

It didn’t have to be this way.  Had Maine joined the rest of the New England states and accepted federal funds to expand Medicaid to cover the working poor, the Portland Free Clinic likely would not be in jeopardy.  69,500 people statewide would have coverage, and fewer would remain reliant on free care. Treating people costs money.  During the Medicaid debate in the legislature and the media, opponents dismissed the expansion as unnecessary, and some even advised the uninsured to sign up for hospital free care, as if this were a simple solution.  It’s not.  Pushing patients onto free care burdens hospitals and clinics with the costs of treating the uninsured.

In states using federal funds to expand Medicaid, hospitals and clinics are getting significant relief from the burden of uncompensated care, and it’s shoring up their bottom lines.  Ultimately, this normalizes rates for everyone – the privately insured no longer have to pay more to cover the costs of treating those who cannot pay.  Publicly traded hospitals report significant decreases in uncompensated care, and community health clinics are also benefitting.  Community health clinics mainly serve the low-income and working poor: this leaves them vulnerable to higher caseloads when more and more patients are uninsured.  2.9 million previously uninsured community health clinic patients are now covered in expansion states.  These patients will generate an estimated $2.1 billion in new revenue this year.

Maine’s 18 community health clinics serve 181,000 Mainers, including 26,000 who are uninsured.  A study by the George Washington University School of Public Health estimates that if Maine had expanded Medicaid this session, 21,000 patients would have gained coverage, resulting in $5 million in new revenue distributed among the clinics. Only 4,000 patients would remain uninsured and reliant on free or reduced care.

The Portland Free Clinic has done an admirable job serving its clients and fills a critical role for Cumberland County.  Now its future looks tenuous.  Had policymakers expanded Medicaid to cover the uninsured, the story probably would have a much different ending.

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