THE BLOG

What's Missing From the Obamacare Debate?

04/20/2015 11:01 am ET | Updated Jun 20, 2015

By the time you read this article, I will be on my way to Kansas City, MO or heading back home to Louisiana after volunteering at a massive free medical clinic. This is not my first time working with the National Association of Free and Charitable Clinics (NAFC) as a volunteer and definitely won't be my last for several reasons. Firstly, I enjoy volunteering and assisting the hundreds of medical and non-medical staff who simply come out to help those who can't access quality affordable health care. Secondly, even if the Affordable Care Act (ACA) aka Obamacare were to roll out flawlessly, there will still be millions of hard working Americans who can't afford health insurance.

As the Supreme Court prepares to decide the future of the ACA, the conversation has focused on the potential impact of the outcome. Specifically, that striking down federal subsidies for policy holders could create a nation of haves and have nots -- those with coverage and those without. What's lost in this debate is that when it comes to health care coverage, this already is a nation of haves and have not's, and the ACA hasn't solved that. The law does a great job for some people, but it leaves an incredible number of hard working Americans -- as many as 30 million, as estimated by the Congressional Budget Office -- falling through very large cracks.

As of March 2015 16 states have opted out of expanding Medicaid, leaving large gaps in coverage available for nearly 4 million adults. Lacking other options, many of these patients are currently receiving care in one of America's 1,200 Free or Charitable Clinics, which are part of the NAFC. These organizations -- which provided over 6 million patients visits last year alone -- are driven by a volunteer workforce of doctors, dentists, nurses, therapists, pharmacists, nurse practitioners, technicians and other health care professionals.

After volunteering for my sixth massive one-day clinic, I truly understand their significance. One of the most common misconceptions about how the United States will look after the full implementation of the Affordable Care Act (ACA) is that there will no longer be a need for these clinics to continue to provide charity care as a member of the safety net. Nothing could be farther from the truth. Despite the implementation of Obamacare, many of the clinics have seen a 40 percent increase in patient demand over the past two years.

A 2014 Kaiser Family Foundation update reported that two-thirds (66 percent) of people in the coverage gap are in a family with a worker and 54 percent are working themselves. These patients aren't freeloaders. They are hard-working people. They are people with jobs -- often more than one -- who are trying to take care of their families. They are freelancers and millennials; they are service industry workers, professionals, and everyone in between. Most importantly, they are people who shouldn't be financially ruined just because they need to pay for a health care expense.

In states that have expanded Medicaid, there may be some relief when it comes to purchasing health insurance given that adults under the age 65 can earn up to 138 percent of the federal poverty level and qualify for Medicaid. However the federal poverty level for this year is only $11,670 for individuals, which means one would need to earn less than $16,243 to receive Medicaid coverage. This is hardly wealthy by most standards.

The ultimate irony is that under the ACA, people earning more than $16,243 can receive subsidies to purchase insurance through the exchanges and to lower their out-of-pocket costs. However, individuals are still reporting to our clinics that even with the subsidies they can't afford medication, find a doctor for a timely appointment and can still not access dental care. In fact 70 percent of our clinics are reporting that patients are returning to them for help even after that have found coverage.

The Affordable Care Act was just a first step in providing access to affordable health coverage for some Americans; it was not a final step in providing care for ALL Americans. Currently in our health care system there are those who still have to make the choice between putting food on the table or paying for health care. For them, it is quite literally a matter of life and death. For those people, I will continue to volunteer and the Free and Charitable Clinics will still be here, continuing to build a healthy America, one patient at a time.