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Will ACA Eliminate Need for Free Clinic? (Audio)

For nearly 25 years, the Brandon Outreach Clinic has provided free health care to people who can't get care any other way. The Affordable Care Act is supposed to change that.

Starting Jan. 1, the federal Affordable Care Act will require most people to buy health insurance or face a tax penalty. Large employers will have to provide coverage to their employees who work at least 30 hours a week, at a price the worker can afford. Those who are self-employed or work for small businesses will have to seek coverage through the federal online marketplace, which will provide subsidies to those with incomes as low as the federal poverty level.

"We take care of the in-betweeners," said Suzy Watts, the medical coordinator at the clinic. "People who just work hard but don't work at a fancy job with fancy benefits." 

That's Brandon Outreach's core patient population. So if they're going to be covered through their work or the exchange, does that mean the clinic will be out of business? Executive Director Debbie Meegan is skeptical that everyone will enroll in plans right away.

"I think that's the problem," Meegan said. "They're just not anticipating it being seamless. It's just a big unknown."

Watts says about 80 percent of the people who call the clinic actually qualify for help somewhere else, either through the Hillsborough County Health Care Plan or Florida's Medicaid program. The county health plan is funded by a half-cent sales tax and is open to residents of the county who are at or below 100 percent of the poverty level. Medicaid in Florida mostly excludes childless adults, no matter how low their income. 

"We help people who are between the poverty level that is roughly $900 a month for a family of one, to double that, which is $1,800 a month," Watts said. "Basically, this translates to anyone on unemployment, disability, people earning minimum wage or people above minimum wage who do not have a full time job."

Patricia Wise-McDonald is like many of the patients who come to the clinic, people who are finding themselves uninsured for the first time. Her profession is human services, and she has always had health insurance, until she was recently laid off from the Polk County Board of Commissioners.

"This is a different species for me," Wise-McDonald said. "I'm used to being on the other side of this desk."

She has diabetes, so going without health care isn't an option.  She now works part-time at a Christian school and does some consulting work, but neither of those jobs offers her health insurance. 

Wise-McDonald says she looked into buying health insurance. Finding a company wasn't the problem. It was the price: more than $500 for just her. 

"I can't afford to do that," Wise-McDonald said. "Not with this income."

The Brandon Clinic doesn't charge for services or take any kind of insurance, including Medicaid. They are funded by grants and donations -- and doctors and specialists who give their time and services.  When Wise-McDonald had to see a neurologist and a cardiologist, both doctors saw her in their own offices.

"They treat you just like you're a regular patient, a paying patient," Wise-McDonald said.

Most of the clinics' patients have a job. Lucy Conrado used to have insurance through her last employer, but she now works part-time for AT&T. 

"They don't pay very well," Conrado said. "It's not like I don't work, they just don't pay me enough. I can't have the health insurance."

She said she has to choose between buying health insurance or groceries. 

"It's very, very expensive, so I can't afford it," Conrado said. "I only work 36 hours and I make less than $1,500 a month, and for health care just for myself it would be $200 every other week." 

A spokesperson for AT&T confirms there is a waiting period for new hires to qualify for company subsidies for its health insurance. The company would not say how much an average employee pays for health insurance, or talk about Conrado's case.

"AT&T can’t answer specific questions about the benefits situation of an individual employee," Michele Money-Carson, senior public relations consultant of AT&T Corporate Communications for West Florida, wrote in an email.

"I have to have those things every day," Conrado said. "If I don't take the medicine, I can die."

Conrado says she has to work for the company for several months before the health insurance premiums go down. Without affordable insurance, Conrado found herself at the clinic, where she gets free medication to treat her diabetes and high blood pressure. 

"I have to have those things every day," Conrado said. "If I don't take the medicine, I can die."

According to one recent poll, more than 40 percent of Americans don't even know the federal health law still exists. But it does, and many more provisions will kick in during the coming months. Here are some resources that can help you plan:

  • A health insurance subsidy calculator that can tell you if you qualify for premium assistance  to help you buy insurance.
  • A timeline of what changes are coming and when.
  • Links to more stories from Health News Florida and NPR about the Affordable Care Act.

Lottie Watts covers health and health policy for Health News Florida, now a part of WUSF Public Media. She also produces Florida Matters, WUSF's weekly public affairs show.