In Wisconsin, Free Clinics Brace for More Fallout

MADISON, Wisc. (WOMENSENEWS)–Implementation of the Affordable Care Act is making life volatile for 70 free or charitable clinics at work in the Badger state, which has a population of 5.76 million.

Gov. Scott Walker’s defunding of Planned Parenthood clinics four years ago, combined with his refusal to accept federal aid to expand Medicaid, the low-income health insurance program, have both steered patients to free clinics.

Now there’s a Supreme Court decision looming even larger.

Katherine Gaulke is executive director of the Wisconsin Association of Free and Charitable Clinics, in Dodgeville, which was created in 2014. Her umbrella organization is now strategizing with the national free clinic association on how to respond in the event that the United States Supreme Court, in the King v. Burwell case, eliminates federal health care subsidies in the 34 states — including Wisconsin — that did not establish state-based health insurance exchanges.

Since more than 87 percent of the Wisconsin residents who bought policies through the marketplace could lose their federal subsidies because of the case, the need for more free and charitable clinics here would rise sharply. A decision in the landmark case is expected in June.

"It’s hard to tell how this is going," Gaulke said in a recent phone interview. "There are all kinds of strong reactions on the blogs. But we have to be ready, no matter what. It’s our dream that everyone has health care. We’ll be here until that happens."

Many free clinics are already trying to respond to clients’ increased need for obstetrics-gynecology services, which may continue to grow.

And in the midst of tax season, many people who underestimated their 2014 income are learning that they will lose some or all of the subsidies they’d been counting on to pay their bills. This group could also wind up seeking care at free clinics.

Clientele Down at Specialist Clinic

Benevolent Specialists Project, located in Middleton, is the only free specialty clinic in the state. With more people now covered due to the Affordable Care Act, the clientele is down 25 to 50 percent at Benevolent as well as many such clinics that provide primary care.

But some other free clinics are seeing a rise in demand, said Gaulke.

Access to free clinics varies because each clinic can set its own income standard, which leaves many people in limbo. "Because so many of the new uninsured are adults, the need for free clinics is still there," said Gaulke. "Since so many Planned Parenthood clinics closed, there was a new demand for ob-gyn services. Some free clinics have added those services."

In 2011, Walker signed a budget that eliminated funding for Planned Parenthood to help plug a $3 billion shortfall without raising taxes.

As a result, five Planned Parenthood clinics in Wisconsin, including some that provided no abortion services whatsoever, have closed and those that remain are struggling.

Abortion services are not covered by insurance purchased through the marketplace because President Barack Obama in 2010 signed an executive order ensuring that federal funds not be used for abortions except in cases of rape, incest or when the life of the mother is endangered.

Most of the services that the closed Planned Parenthood clinics in Wisconsin provided to 3,000 patients were annual exams, breast cancer screening and STD and pregnancy testing. The burden of providing those services for uninsured women, as a result, has shifted to free and charitable clinics.

Because of the rampant confusion that has resulted from all the changes brought by the restructuring of health coverage, some free clinics also provide in-house health insurance advisers. Many of the clinics are equipped only to provide patients with referrals to outside experts who can help them through the quagmire of insurance regulations.

Because the need for reliable information is so great, free clinics are trying to expand their reach through social media, said Gaulke. "This is all very confusing and a lot of people give up trying to find affordable insurance."

Some people are being preyed on by websites that claim to be sites for government health insurance, when they are actually just sales vehicles for expensive insurance, Gaulke added. The only reliable site to use is www.healthcare.gov.

Many are also unaware that while the official deadline for signing up for the Affordable Care Act was Feb. 15, there is a special "tax season" enrollment period until April 30 to accommodate people who might not have previously known if they were eligible for a government subsidy, or how much it would be.