After Charity Hospital in New Orleans closed in the wake of Hurricane Katrina, community clinics filled the gap in care for the poor and uninsured.
Once a temporary solution to a crisis, the network of clinics has become the preferred healthcare model for low-income residents in the New Orleans area, and now stakeholders and advocates are scrambling to find permanent funding.
Post-Katrina Healthcare for the Uninsured
On a tour at the Daughters of Charity Services’ flagship clinic off Carrollton Ave. in New Orleans, President and CEO Michael Griffin proudly pointed out the many services it offers.
"So the vision was to incorporate primary care, dental, behavioral health, pharmacy, optometry all in one-stop-shop location to take care of patients more holistically," said Griffin.
Daughters of Charity was one of the community organizations to step up to provide healthcare services for the uninsured after Hurricane Katrina. Griffin said quickly opened temporary locations.
"We were in the rectory of a church over in Bywater, we had a temporary office at Ochsner Baptists Hospital professional building and then we relocated here," said Griffin.
Immediately after the storm, clinics like this one were bolstered with a $100 million federal grant. When that money ran out in 2010, the grant was restructured into a program funded with state and federal Medicaid funds. That program, which covers primary and behavioral health services for thousands of adults who don’t qualify financially for Medicaid, was set to expire at the end of this year - right as Medicaid was supposed to be expanded under the Affordable Care Act.
But the US Supreme Court struck down the requirement that all states expand Medicaid and Gov. Bobby Jindal opted out, saying it’s too expensive. Griffin said this means if the program is allowed to expire, the 63,000 some enrollees in the program would go back to being uninsured.
For the Daughters of Charity, that’s about one-third of their patient population.
"So technically one-third of our revenue from seeing patients would go away," said Griffin. "We would have to change some of the ways we provide care."
Not only would the clinics who participate in the program lose a big chunk of their revenue, the emergency room would again become the only real option for the people dropped from of the program because the clinics that once served them would more than likely not be able to afford it anymore.
A Potential for Change
New Orleans Health Commissioner Dr. Karen DeSalvo said prior to Katrina, the city relied on emergency ooms for the care of the uninsured. But when the clinics started providing care for that population in their own communities, the city quickly realized this was an opportunity to build a foundation for a whole new health system.
"One, grounded and founded in primary care because the data says if you have a healthcare system that grounded in primary care and prevention and people have access to quality care like that then better health outcomes, better cost equations, less deaths," said DeSalvo.
Although no official studies have yet been done to measure health outcomes in the post-Katrina network of clinics in New Orleans, experts have touted the benefits of health-center based primary care for years. A recent study by the National Association of Community Health Centers shows a nation-wide trend over the last decade that increased access for the uninsured to community clinics has improved health outcomes by ensuring patients have a regular source of care, improving access to preventative services and reducing health disparities for minority patients - all while reducing costs for taxpayers and insurers.
State Department of Health and Hospital Secretary Kathy Kliebert said they are working with the city of New Orleans to find a funding solution.
"We think they’re working to improve access," said Kliebert. "We’re certainly looking at any models, whatever they may be that provide those safety net services."
She said the recent extension of the program through 2014 required, among other things, changing the financial eligibility from at or below 200 percent of the federal poverty level to only 100 percent since the Affordable Care Act will now cover people over 100 percent of poverty in the exchanges. Kliebert said some 25 percent of program participants can be rolled over onto the exchanges, where they will more than likely qualify for subsidies to buy their own health insurance. But that change isn’t automatic. Patients must sign up for the exchanges or find themselves uninsured again come Jan. 1.
Maybe Not Just For NOLA
Back at the Daughters of Charity clinic, CEO and President Michael Griffin hopes there will be a permanent funding solution eventually so the program can continue in New Orleans and maybe one day beyond.
"I think this model could be replicated in other places because it really puts funding for healthcare where it has it’s biggest bang for the buck," said Griffin.
But for now, Griffin said the Daughters of Charity – like many other clinics in their situation – will seek grants and other funding sources to keep them afloat if the program expires at the end of next year.