The class and financial borders in Bridgeport, Connecticut’s largest city, are prominent. Within a 10-minute drive, the landscape in any which way can go from tidy, two-story homes with picket fences to burned-out buildings and blighted neighborhoods.
It’s this divide that has ranked Connecticut — and specifically Fairfield County — as one of the best (or worst, rather) examples of America’s wealth gap. It’s also home to more than 83,000 people who are uninsured — the leftovers from Obamacare who are either undocumented or can’t afford private health insurance.
And it’s those residents who Dr. Ken Grossman thinks about when he volunteers once a month at the Fred Weisman Americares Free Clinic in Bridgeport, about 30 minutes south of his main practice.
“There’s this paradox where we’re the richest and the poorest county in the nation,” Grossman tells NationSwell. “The population I see, they are some of the hardest working people. Some of the poorest too, but it’s because of that they take nothing for granted.”
Grossman is one of thousands of doctors that volunteer their time at free clinics, of which there are about 1,200 across the nation serving 6 million people, according to the National Association of Free and Charitable Clinics. Their mission is simple: provide free healthcare to those who can’t afford it. These medical facilities were the lifeblood for the uninsured before the Affordable Care Act. But as Medicaid expanded in 31 states, including the District of Columbia, following the law’s passage, more people were able to get coverage, leaving free clinics fighting for survival.
Now, with national healthcare on unsteady ground, there could be more people relying on these clinics again, but there’s a dearth of skilled and well-practiced physicians willing to volunteer.
“If you ask me what I need, I’ll always tell you dollars and docs,” says Karen Gottlieb, executive director of Americares’ four free clinics in Fairfield County. “And we desperately need docs.”
DOCTORS’ DISAPPEARING ACT
Volunteering among professionals has seen a gradual decline over the past six years, according to data from the U.S. Bureau of Labor Statistics. The percentage of volunteers with advanced education, including doctoral degrees, dropped from 42.4 percent in 2011 to 38.8 percent in 2015.
And though more than 90 percent of physicians emphasize that volunteering or community outreach is paramount for their jobs — specifically helping the poorest patients — only 39 percent have volunteered their time, according to a 2008 survey.
“Pro bono work in law is mandated, but you don’t have that in medicine,” says Yasmin Meah, founder and program director for Mount Sinai’s East Harlem Health Outreach Program, a free clinic in New York City. “A few years ago we were really struggling as far as recruiting and maintaining volunteers. We’d have to close about four to five times per year because there were no volunteer physicians.”
The decrease in volunteers has forced clinics like Meah’s to get creative in attracting doctors to donate their services. One way they’ve done so is by offering malpractice insurance for physicians, which can cost thousands of dollars a year. Americares’ clinics, for example, provides liability coverage to its volunteer doctors — an incentive that convinced Grossman to get on board.
Still, covering malpractice isn’t the answer in every case. Free clinics affiliated with hospitals, like Mount Sinai’s for example, often prefer to work with doctors who currently practice at the hospital, because their insurance is already covered. This in turn can lead clinics to pass up the services of older, retired physicians, who otherwise have the time, experience and desire to volunteer.
It’s a conundrum that’s only become more pronounced as clinics, most of which rely on a shoestring budget and bare-bones volunteer staff, struggle to stay open. After the rollout of the ACA, many had to convince donors to keep funding their operations, says Sasha Bianchi, executive director of Volunteers in Medicine.
“The challenge was the perception more than the reality of the situation,” says Bianchi. “Everybody was thinking, ‘Oh, society solved [the uninsured] problem, so I’ll send my money somewhere else.’”
DIAGNOSIS: MORE TROUBLE AHEAD
Despite the uninsured rate dipping to 9.1 percent in 2015, a record low in the U.S., there has been a slow trend upward that has many clinic leaders worried — and fighting for funding.
According to the Gallup Health Index, the uninsured population saw an increase to 11.7 percent in the second quarter of 2017. The reasons behind the uptick are numerous: insurers leaving the ACA, higher premiums and an uncertainty of where the law will go under the current administration.
But that could all change, for the worse, as higher premiums proposed next year push more people back into the uninsured ranks. In June of this year, the two companies in Connecticut selling individual plans through the ACA — Anthem and ConnectiCare — have both proposed rate increases for 2018, ranging from 17.5 to 33.8 percent.
And Americares’ clinics won’t be able to treat everyone, says Gottlieb.
“We’re only taking care of 3,200 of them, and there are a lot more people out there who don’t have insurance,” says Gottlieb. “We could see more patients if we had more resources, but we are resource-constrained.”
‘I’M GOING TO HELP THEM’
For those clinics that didn’t close their doors, they became de facto medical homes or navigation facilities. And many were able to rise to the challenge as demand fell and patients were able to be seen faster and more frequently.
Which is all good news, as free clinics also provide a training ground for medical students. At the East Harlem Health Outreach Program, any given Saturday will see 35 volunteer med students working, all of whom get to see the troubles facing a beleaguered population whose health is sometimes made critical by lack of consistent or quality healthcare.
It’s that same population, about a quarter of which are immigrants, that Grossman, the Americares volunteer, loves to help, despite the political arguments against the undocumented and their use of the healthcare system.
“I became a physician to take care of people,” he says. “These are people. They have hearts, arms, brains and medical issues, just like everyone else. And I’m going to help them.”