Bacon's Rebellion

Democracy Thrives in Sunlight

Danville Free Clinic Bites the Dust

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James A. Bacon
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by James A. Bacon

Before Virginia embarked upon Medicaid expansion, the state had a network of free clinics that provided primary-care services to people lacking health insurance. It was an imperfect safety net, to be sure, but at least it was something. Now, more than a half year into Medicaid expansion, that safety net is fraying in places.

The Free Clinic of Danville has closed its doors after experiencing a sharp drop in patient volume, reports GoDanRiver.com. In operation since 1993, the clinic survived on state grants, local foundation grants, private donations, and volunteer labor.

The drop in patients following Medicaid expansion was felt almost immediately. The clinic, which had 187 patients at the end of 2018, had only 15 by July. The remaining patients are being transferred to Piedmont Access to Health Services (PATHS), the SOVAH Family Medicine Residency Clinic and other providers.

The good news here is that Medicaid Expansion apparently leaves few Danville-area residents without access to primary care services of some kind. Another positive spin on this story is that the Danville facility is the only free clinic in Virginia to have closed so far. Some clinics have embraced a hybrid clinic that accepts Medicaid patients, although making the switch requires meeting Medicaid regulations such as having someone on call 24/7 and upgrading computer systems. Other clinics have cobbled together the resources to survive even after the loss of Medicaid patients.

My worry has been that Medicaid expansion will drive the back-up primary care system out of business, leaving no safety net should a debt-addled federal government one day renege on its promise to cover 90% of expansion costs and should the General Assembly decide it cannot afford to continue the program. Fortunately, that fear has proved to be mostly groundless…. although the experience of the Danville clinic shows that some clinics may be vulnerable.

In the meantime, a more pressing problem is the increasingly acute physician shortage, which makes it difficult for Virginia’s poor to find primary care whether they have Medicaid or not. As a consequence, hospital emergency rooms are as full as ever. And as we all know, emergency rooms are outrageously expensive settings for delivering primary care.

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8 responses to “Danville Free Clinic Bites the Dust”

  1. Steve Haner Avatar
    Steve Haner

    Yeah, right, this is a bad thing. We should get rid of SNAP and WIC so people can go back to standing in line at food pantries and soup kitchens.

    1. James A. Bacon Avatar
      James A. Bacon

      Sarcasm is not an argument, especially when the sarcasm implies things that the author has never advocated.

  2. LarrytheG Avatar
    LarrytheG

    This is an interesting way of framing a success! Thousands of people who didn’t have acess to health care – now do and so yes, the clinics of last resort have lost those folks to – not ERs – but doctors – and the “shortage” is bringing physcian assistants and nurse practicioners online – as well as those being jobs in regions that need jobs.

    It’s always a half glass proposition and BR typically looks at the bad side sorry to say.

    More people have access to health care and that is bringing more health care professionals online to provide that care – AND those are jobs in places that actually need those jobs!

    The private sector did not do this. It was never going to do it no matter how “transparent” prices might be – another canard being tossed about as a “solution” that has absolutely nothing to do with folks who WORK for a living but cannot afford insurance – yes that’s what the Medicaid expansion is about.

    The folks opposed to this – in addition to blathering about price transparency also seem to favor dumping people with pre-existing conditions – i.e. don’t require insurance to cover them.

    It’s okay to oppose something if you have a better alternative but when it comes to issues like health care – it’s a blame game of whatever improvements have been brought – i.e. “Medicaid is bad because it’s causing clinics to close and causing a doctor shortage, etc, etc ”

    This is one big major reason why I no longer support the GOP nor so-called Conservatives – both are totally feckless on this issue. Lots of blame – no solutions – just blather and blame (like blaming poor folks for bad health habits – never mind the rich also have them…also~
    just blame those who don’t have jobs employer insurance.

    Remember, these are people who work – these are the folks that basic Medicaid will not cover and the purpose of Medicaid Expansion. These are working men and women who had to depend on free clinics for their health care and now that they can get basic health care – the concern from Conservatives is that the emergency clinics are closing and there is a doctor shortage. go figure.

    1. James A. Bacon Avatar
      James A. Bacon

      “It’s always a half glass proposition and BR typically looks at the bad side sorry to say.”

      Yeah, I do often look at the bad side — the half-empty glass. Because no one else does. Most people follow the conventional wisdom like sheep. Sometimes the conventional wisdom is right, sometimes it is wrong. Someone needs to be the voice of skepticism.

      Obviously, that won’t be you. You have taken on the role as defender of the status quo. Go for it. Baaaah! Baaaaah! Baaaaah, Larry, Baaaaah!

  3. Steve Haner Avatar
    Steve Haner

    Well, technically, expanding Medicaid eligibility was “change,” and the previous reliance on free clinics was the status quo. You were implying that the loss of traffic into the free clinics is a bad thing. I guess you could call my wise ass response sarcasm, but I’d opt for reductio ad absurdum, taking your argument over health care and applying it to feeding programs….

    One clinic in Danville does not a trend make, but it is an issue worth exploring. I suspect the clinics will still have needs to fill. It would not be a bad thing if the demand really is diminishing. The reason I came down in support of expansion personally was the hope (perhaps unrealistic) that more people would actually get into a stable “medical home.”

    1. James A. Bacon Avatar
      James A. Bacon

      That was a reasonable hope. Now, almost a year into the program, it is worthwhile to ask if Medicaid expansion is having the impact that its proponents hoped it would. Maybe it will, maybe it won’t. But someone has to ask… and I don’t see anyone else asking.

  4. Peter Galuszka Avatar
    Peter Galuszka

    I believe a free health outreach in wise county also can cut back due to medicaid expansion. The true, humanitarian question us what took so long?

  5. Steve Haner Avatar
    Steve Haner

    They did not see it drop off this year, not yet. That health fair gets into services not covered by Medicaid (dental for example) and I think for many has become an annual thing on their calendars. What took us so long? It never would have happened until Congress promised to pay 9o percent (don’t hold your breath on that) and messed with the payments to hospitals for uncompensated care. Pre-ACA it would have been much harder for VA to justify doing this.

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