Now that the Supreme Court has upheld the constitutionality of the Affordable Care Act (ACA), much has been written about the potential impact of the law, especially for those without health insurance. Nonprofit organizations like Volunteers in Medicine (VIM) await the implementation of the law in 2014 to learn firsthand how well communities are prepared to welcome the newly-insured into the local "system of care."
Currently, there are 92 VIM clinics in 28 states. These clinics provide primary health care services, without charge, to the medically uninsured in their communities. Care is delivered by local medical and nonmedical volunteers, especially retired medical professionals who enjoy practicing "pure medicine" in an environment of caring and compassion. Each community takes great pride in supporting a robust safety-net clinic so that everyone has access to a basic level of health care. Hundreds of thousands of people have received quality health care in VIM clinics and will continue to do so as long as that care is needed.
In most VIM communities, people who live or work there and have an income at or below 200 percent of the federal poverty level are eligible to receive care. Under the ACA, many will qualify for subsidized insurance coverage and will have their own primary care provider, no longer needing services at the VIM clinic. Yet others will not qualify for health insurance coverage and will continue to need care from community-supported clinics. One big unknown is how state Medicaid programs will factor into health insurance coverage for the uninsured. There is currently enormous variability within states as to who will be covered by Medicaid and who will not, guaranteeing large numbers of the uninsured will remain so.
VIM clinics will be there to care for those who cannot qualify for insurance coverage and are without the means to purchase private insurance. An example is Mary Jones, a 42-year-old single mother of two teenage children. Her children are enrolled in the state Medicaid CHIP program with their own family physician but Mary, who works full-time as a home care aid, could not afford the health insurance premiums available from her employer. She sought care at a VIM clinic for an infected foot, worried that her foot wouldn't heal and would interfere with her ability to work and support her family.
At Mary's first VIM clinic appointment, it was discovered that she had uncontrolled Type 2 diabetes in addition to, and probably related to, her infected foot. This was the first time she had been seen for a medical evaluation for as long as she could remember. The physician at the VIM clinic who cared for Mary prescribed medications for her diabetes as well as for the foot infection. In addition, it was recommended that she follow a 1500 calorie diet, exercise daily for 20-30 minutes and come back in a week for instruction in blood glucose monitoring. She also participated in classes on diabetes self-management. After 2 months, Mary's blood glucose levels were normal, she had lost 12 pounds and her foot infection was gone.
She still requires monthly maintenance visits and needs more preventive care, but overall, her acute medical problems were stabilized, enabling her to continue working at a job she enjoys and support her children. And the volunteers who provide her care are deeply satisfied with the outcome: a win for Mary, her community and the volunteers!
Last year, VIM clinics provided primary medical care to over 100,000 people and over 400,000 patient visits. In doing so, the quality of life for patients and volunteers was improved, including the health of the communities supporting our clinics. This is the mission all VIM clinics strive to achieve, regardless of health care policies or politics. Volunteers in Medicine clinics will be needed indefinitely to continue to care for those who remain uninsured, who fall through the cracks or are unable to afford health insurance.