By Rufus Phillips
In 2021, Virginia’s 60-member network of free and charitable clinics provided $100 million in care to more than 63,000 vulnerable patients. It’s a remarkable number given the trials and tribulations of the last few years and underscores the substantial community contributions clinics make to improve Virginia’s overall health through accessible, inclusive and quality health care.
With a legacy of service starting 50 years ago, free clinics in Virginia continue to provide unwavering care for people in need. If any reminder of the network’s steadfast commitment to supporting Virginians is required, one only needs to look back on the past two years and their response to the COVID-19 health crisis.
Almost overnight, clinic teams innovated, procured personal protective equipment and jumpstarted telehealth solutions to continue safely caring for the state’s uninsured populations, numbers that ballooned because of job losses. Clinics kept patients out of strained emergency rooms and helped Virginians manage pre-existing chronic conditions that could not be ignored during the pandemic.
In short, Virginia’s free clinics never slowed down in the face of our generation’s most significant public health emergency. But as the network of clinics has grown smarter, more resilient, and even more agile in the face of COVID-19 and its many variants, significant, systemic health care challenges remain.
For a variety of reasons, too many people missed important preventative care appointments during the pandemic. A study published in the Journal of the American Medical Association revealed that 41 percent of patients skipped care during the early part of the pandemic. That statistic is even more unsettling when you take into account that low-income communities were already forgoing care because of financial constraints even before the pandemic.
When multiple monthly bills are competing for your attention, people living on low and constrained incomes are understandably more likely to prioritize childcare, housing and food before accessing health care. A nationwide survey in 2019 revealed that more than half of renters (54%) delayed medical care because they couldn’t afford it, missing out on preventative screenings and treatment while sick. When financial hardship causes chronic conditions like hypertension or diabetes to go untreated, the consequences can be deadly.
Current inflationary trends are exacerbating conditions for many families, especially those who live paycheck to paycheck and feel the sting of rising food, gas, and housing costs. Many of our patients are among the hardest hit, members of the demographic group known as ALICE, an acronym that stands for Asset Limited, Income Constrained and Employed. In Virginia, 10 percent of households are living below the federal poverty line (FPL) at 200 percent, while 29 percent (almost three times as many) are ALICE households with incomes ranging from 200 percent to as high as 400 percent FPL according to the 2020 Virginia ALICE Report. As we continue to navigate inflation, free clinics will become an increasingly important resource for hardworking Virginians within the ALICE population.
Lower-income families will also be impacted when Virginia Medicaid returns to its normal enrollment process. Since the public health emergency declaration at the start of the pandemic, Medicaid members have been able to keep their health coverage even if their eligibility status changed. When the federal public health emergency ends, Virginia and other states will need to redetermine the eligibility for Medicaid members. During the Medicaid unwinding process, it’s essential that all Medicaid-eligible Virginians stay covered and free clinics proactively work with the state, Managed Care Organizations, and nonprofit partners to assist affected individuals. For people who no longer qualify for Medicaid and cannot afford coverage in the individual marketplace, free clinics will be a veritable lifeline and one of their only sources of primary medical care.
Meanwhile, clinics are facing increases in patient demand while continuing to deal with COVID and its long-term health effects as well as experiencing shortages of clinic volunteers and rising operational costs that are straining their capacity. Volunteers are the life blood of clinics and help connect patients with the high-quality care they deserve. But many volunteers have retired or left the health care industry during the pandemic and aren’t returning to clinics, resulting in clinics relaying on paid staffing to compensate.
While clinics are actively recruiting new professionals, like any industry but especially in health care, it takes time to refill the ranks. The increased costs associated with personal protective equipment and sanitation continues to burden budgets as well.
In the face of these challenges, the vital work of our clinics continues, thanks in large measure to the commitment of our volunteers, the generosity of our partners and donors as well as the critical support received from the state, including much needed American Rescue Plan Act funding for FY23 in the biennial budget recently passed by the General Assembly and signed by Gov. Glenn Younkin.
It’s a wise investment that safeguards the health of vulnerable patients and strengthens Virginia’s commitment to keeping our residents healthy.
Rufus Phillips is CEO of the Virginia Association of Free and Charitable Clinics. He can be reached at [email protected].