Health professionals volunteer their services when the ACA isn't enough

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Monya De, MD, MPH, who practices internal medicine and integrative medicine in the Los Angeles area. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Monya De. MD, MPHAt the recent national meeting of the American College of Physicians (ACP), I dropped in on a session about medical volunteering. I thought I might hear about an interesting opportunity to volunteer in Africa, or South America perhaps.

Instead, the first presentation was about volunteering at a free clinic-in America. The physician in charge spoke of an impressive roster of staff-physicians, nurses, medical assistants, who, amazingly, all worked for free to support no-cost healthcare.

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I asked the doctor what kind of patients attended this free clinic. She answered that the patient population included people not served by the Affordable Care Act. These included people who made too much money for Medicaid (her state hadn't participated in the Medicaid expansion), people who couldn’t afford the policies available on the healthcare insurance exchanges, and people who, for reasons of mental illness or addiction, couldn’t navigate the insurance system well enough to figure out how to find and sign up with a primary care doctor and their needed specialists.

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These three groups can be found all around the country, and it’s telling that, even with a national mandate for health insurance coverage, free clinics are still serving a need that should be fully met. As laudable as the Affordable Care Act is, it certainly favors the disciplined (people who can save enough of their income to pay for premiums and exorbitant prescription drug costs), lucky (people without financial burdens like an ailing parent or insane student loan interest rates), tech-savvy (to sort through Internet information to find the perfect insurance plan and properly licensed doctor with good reviews) and, well, healthy.

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A free clinic staffed by health professionals volunteering their time is a dicey safety net. The doctor presenting at the ACP conference expressed her concern that more and more doctors are employed rather than owners of their own practices, leaving them with demanding 8 to 5 schedules (make that 8 to 9 with electronic health records charting) and without the ability to clear Wednesday afternoons to volunteer in the community.

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It's also difficult to find anyone to cover a shift if a nurse or doctor gets sick, since most people are at work.

Senator Bernie Sanders' dreams notwithstanding, we are a long way from government-sponsored healthcare for all. But until then, healthcare policy should be focusing on affordability of mandated health insurance plans for those who have other unavoidable expenses, control of very high deductibles, simple insurance plan sign-ups and information, and better facilitation of matching patients with doctors and other health care providers.

Finally, Medicaid expansion would ease the burden of patients trapped in the donut hole of being too poor to afford insurance, but not quite poor enough to qualify for Medicaid.     

Free clinics are wonderful and an important part of the fledgling healthcare infrastructure in economically struggling areas, but should not be necessary in a wealthy country.

Americans deserve better.