In a small room covered with posters for diabetes prevention and free eye clinics, and a physician’s desk stacked with papers, Karen Cascone meets with her nurse practitioner.
The 58-year-old, who has a thyroid condition and high blood pressure, is following up from the previous week. She suspects her cholesterol is high.
“I quit smoking,” Cascone tells Trudy Grossman, the nurse practitioner.
But, Cascone continues, “I’ve put on a little over 25 pounds, so I’m sure my cholesterol has gone up a bit.”
This kind of appointment – ones Cascone attends a few times a year to keep her conditions in check -- is critical to the St. Pete Beach resident, she said. But since she can't afford a nearly $500 monthly premium she would have to pay for insurance through HealthCare.gov, Cascone said she leans on the St. Petersburg Free Clinic for blood work and prescription refills.
"I can't afford that,” Cascone said of insurance the Affordable Care Act created to make coverage more affordable. “My husband is on Social Security. I work, but only makes about $1,000 a month, so a $500 premium is a lot of money to me."
The St. Petersburg Free Clinic is one of 87 programs participating in the Florida Association of Free and Charitable Clinics. Last year, when the group received $4.5 million from the state budget, the clinics served 125,000 uninsured Floridians. The state money bought new equipment, expanded services and allowed some of the clinics to hire additional staff.
This year, clinic leaders said they expected double that amount. A total of $9.5 million passed both the House and Senate, for the fiscal year that started July 1. But Governor Rick Scott vetoed the line item a week before the budget went into effect.
The clinics got nothing.
The veto led to immediate cuts, said Mark Cruise, executive director of the Florida Free and Charitable Clinic Association.
"Because the veto happened a week before the fiscal year without an prior notice, many people had to be laid off,” he said. “So finding the money to replace that loss of state money is not as easy task, and for some clinics, they'll never replace it.”
Before 2014, the clinics had spent years stitching together a budget from various donors, churches, businesses and grants. They also partner with hospitals and drug companies for discounted services and in-kind donations.
In Miami-Dade County, the Good News Care Center gets help from Baptist Health South Florida and other organizations, but executive director Michael Daily said it's not enough.
"To receive funding from the state legislature is amazing,” Daily said. “It's a tremendous thing because it represents a source of sustainability that we can depend on. It's also great that the state would come alongside us and partner with us and provide care for the people that otherwise provide a great strain on the health care system."
Beth Houghton, executive director of the St. Petersburg Free Clinic, said like many other clinics, the first cuts affected patients with a common chronic disease: diabetes. Now, fewer insulin supplies and diabetes education classes are available.
And Houghton said some patients will suffer.
"You have consequences like loss of sight, loss of limbs, circulatory problems, nerve pain, people not able to work,” she said.
In addition the cuts to diabetes programs, Houghton said the $200,000 cut to the St. Petersburg clinic canceled plans to buy an electronic medical records system and plans to expand dental services.
"All of those are real consequences of not being able to touch more patients,” she said.
Stephanie Garris, executive director of Grace Medical Home in Orlando, said a third of her county is uninsured. Those patients often end up in the emergency room, and that costs the state money, she said.
“It's not appropriate that the uninsured have to utilize the emergency room for primary care services,” Garris said. “There are much more cost effective ways for patients to get care. And my clinic is an example of that."
In January 2016, members of the Florida Association of Free and Charitable Clinics will go before the Florida legislature to once again plead their case for funding. Until then, they're tightening their purse strings and hoping that private donors will step in to fill the gap left by the state.