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Calling the shots

"Calling the shots" Continued...

Issue: "Dead heat," Sept. 22, 2012

One looming concern for charity clinics: What will be the effect of the Affordable Care Act ("Obamacare")? The law gives much more money to FQHCs, causing some free clinics to rethink their mission. Should they become FQHCs or remain as they are? As Pat White put it, "Do we morph into something else? Or stay true to our mission?"

Michael Sowyak, executive director of Shelter Health Services in Charlotte, decided he does not want to change to a business model by chasing Medicaid reimbursements: "If we did that, we wouldn't be able to take 45 minutes for someone who needs extra help. … It would be 10 to 15 minutes per person, get them in and out, to maximize revenue. … They need more than just coming and getting a prescription. They need to have their hand held. They need to be shown respect."

Peggy Dator, president of the Free Clinic Association of Pennsylvania, says some clinics in her network might try to become FQHCs because they struggle to recruit enough volunteer staff. Dator also serves as executive director of a large free clinic in Doylestown: "The clinic I work with partners with a hospital, so we have an overabundance of volunteers. That's not true even half an hour north."

Even if they wanted to become FQHCs, she says, some free clinics might not be located in areas that qualify as underserved: "There are poor people all over, but we just aren't poor enough."

John Mills is managing director of Empowering Community Healthcare Outreach (ECHO), an organization that helps churches and other nonprofits to open medical clinics for the poor. Since 2005, the Fort Worth-based nonprofit has helped plan or open 48 medical clinics around the country, sending consultants to work at no charge with interested people in rural and urban communities.

Mills says even if a charity clinic wants to become an FQHC, funding isn't likely to be available: "It's still going to be really competitive. … Extremely unlikely that you are going to be funded. The money will be going to expansion of existing clinic sites." He sees FQHC paperwork as onerous-"Doing the basic reporting for Medicaid requires a staff to do just that"-and a major downside for doctors who want to practice medicine without having to think about the federal middleman.

Susan Post, executive director of Esperanza Health Center in Philadelphia, says her clinic, which serves a mostly Hispanic population, became an FQHC in 2006. She says government grants for the uninsured and government malpractice insurance help her clinic provide good care. She says what Esperanza wants the government has wanted: 24/7 accessibility, comprehensive care for the whole person, and integrated social services. She even sees an upside to the detailed end-of-year reports the government demands, calling them management tools: "Those are the kinds of things I ought to be doing."

Esperanza's leaders did not want to risk the clinic's explicitly Christian personality, so they highlighted the clinic's Christian mission in their application-and so far, Post says, government money has not changed the mission or its expression. Clinic staffers "offer prayer a lot." Most patients want staff members to pray with them because they "want the Lord in their lives." But Post is aware of recent government actions that threaten freedom of conscience: "We'd rather walk away than change the way we practice," she says, but doing so would "be hard … a very difficult thing."

And there's the danger. If Congress overturns the Hyde and Weldon Amendments, which guarantee that FQHCs don't have to perform or refer for abortion, Christian clinics will be in trouble. The same goes if Congress or an administration acts to prevent FQHCs from hiring people who share their mission. For example, FQHC groups have to tell patients where they can obtain contraceptives, but they don't have to provide contraceptive services themselves. That could change-and as Post acknowledges, walking away from the money would be hard.

Of course, these days even privately funded charity clinics have to navigate tricky waters to provide healthcare for the poor. Diane Steward of Puget Sound Christian Clinic notes some of the hurdles: "We've talked with lawyers, insurance agents, pastors and church administrators, negotiating agreements to use space in several churches and nonprofits and provide healthcare together. ... We called city licensing departments in several different communities to ensure we are meeting all legal and licensing requirements in each community."

But at the end of the day, private charity clinics answer only to their patients and funders-not to bureaucrats or legislators who have become increasingly hostile to religious expression: Just ask Catholic Social Services in Boston whether it's still able to provide adoption and foster care services.

Susan Olasky
Susan Olasky

Susan pens book reviews and other articles for WORLD as a senior writer and has authored eight historical novels for children. Susan and her husband Marvin live in Asheville, N.C. Follow Susan on Twitter @susanolasky.

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