by James A. Bacon
Before Virginia embarked upon Medicaid expansion, the state had a network of free clinics that provided primary-care services to people lacking health insurance. It was an imperfect safety net, to be sure, but at least it was something. Now, more than a half year into Medicaid expansion, that safety net is fraying in places.
The Free Clinic of Danville has closed its doors after experiencing a sharp drop in patient volume, reports GoDanRiver.com. In operation since 1993, the clinic survived on state grants, local foundation grants, private donations, and volunteer labor.
The drop in patients following Medicaid expansion was felt almost immediately. The clinic, which had 187 patients at the end of 2018, had only 15 by July. The remaining patients are being transferred to Piedmont Access to Health Services (PATHS), the SOVAH Family Medicine Residency Clinic and other providers.
The good news here is that Medicaid Expansion apparently leaves few Danville-area residents without access to primary care services of some kind. Another positive spin on this story is that the Danville facility is the only free clinic in Virginia to have closed so far. Some clinics have embraced a hybrid clinic that accepts Medicaid patients, although making the switch requires meeting Medicaid regulations such as having someone on call 24/7 and upgrading computer systems. Other clinics have cobbled together the resources to survive even after the loss of Medicaid patients.
My worry has been that Medicaid expansion will drive the back-up primary care system out of business, leaving no safety net should a debt-addled federal government one day renege on its promise to cover 90% of expansion costs and should the General Assembly decide it cannot afford to continue the program. Fortunately, that fear has proved to be mostly groundless…. although the experience of the Danville clinic shows that some clinics may be vulnerable.
In the meantime, a more pressing problem is the increasingly acute physician shortage, which makes it difficult for Virginia’s poor to find primary care whether they have Medicaid or not. As a consequence, hospital emergency rooms are as full as ever. And as we all know, emergency rooms are outrageously expensive settings for delivering primary care.
