June 26, 2017



Deutschlandfunk / German National Public Radio

Filling The Gaps in the Safety Net

Charity clinics and community health centers are bracing for a major increase in uninsured patients, as efforts mount in the U.S. Congress to repeal and replace Obamacare. More than 20 million Americans could lose their coverage under a new legislation.

By Katja Ridderbusch

Atlanta, Ga. -- The waiting room at the Ben Massell Dental Clinic is packed with patients, each of its 16 treatment rooms is occupied. Whether it's a cavity or a crown, a root canal or an infected wisdom tooth, dentures or implants: The downtown Atlanta clinic handles almost every dental ailment.

It's a normal day in a not so normal dental office.

"The Ben Massell Dental Clinic provides free service to the unserved in Atlanta," says the clinic's director, Keith Kirshner.

The clinic was founded 106 years ago by a group of Jewish dentists. It receives no government funding and relies exclusively on private support from Jewish service organizations, as well as foundations and philanthropists.

The 7,900-square-foot clinic has a bright and modern appeal, with lots of glass, wood, and the latest state-of-the art equipment. About 150 dentists work here, each of them once a month, sometimes more often. All are volunteers.

"We try to fill the gaps in the safety nets," says Kirshner, "to be a response to the need that exists."

About 50 patients, Jewish and non-Jewish, seek treatment at the clinic on any given day. Like the woman who is here today for a tooth filling.

"I got laid off and lost my health insurance," she says. In the U.S., the majority of people get health insurance through their employer. She couldn't afford a dental plan on the private market, so she came to the Ben Massell Clinic three years ago.

"I feel welcome here," the woman says. "And I feel safe."

Ben Massell is one of about 1,200 charitable clinics in the United States. There's always a need for their services, says Kirshner, even though the need fluctuates, depending on political and economic changes.

“During the recession 10 years ago, we did notice a spike in terms of the need," Kirshner remembers. "That has largely remained the same since."

Under the Affordable Care Act, called Obamacare by friends and foes, more than 20 million additional people were able to obtain health insurance in the U.S.  Dental care, however, was never part of the law. That's why Kirshner does not expect an immediate impact on his clinic, if Congress passes a bill to repeal and replace Obamacare, making good on one of President Donald Trump's loudest campaign promises.

"We as a clinic don't expect any significant change," says Kirshner. "But we continue to monitor these issues. And we anticipate as a whole, that the needs of the community will increase."

Both the House and Senate versions of the new health care bill could lead to a situation where more than 20 million people would lose their insurance by 2026, according to an estimate by the independent Congressional Budget Office (CBO).

The Ben Massell Clinic receives about 400 requests a day from new patients, says Kirshner.

"And we can't even come close to meeting those."

That's a problem employees at Mercy Care are all too familiar with. Mercy Care, founded by the Catholic Sisters of Mercy, is a community health center with several locations in and around Atlanta. The main clinic is downtown in a red brick building set in a row of narrow warehouses with metal sheet roofs. Freight trains are rattling by on the nearby tracks.

"We offer routine primary care, preventative services, diagnostic services, dental and vision care," says Tom Andrews, president of Mercy Care. "We also have integrated behavioral health services, so patients can be evaluated for mental health issues."

Most of the 95 people, who come through the door at the downtown clinic every day, live at or below the poverty line. Many are uninsured, have lost their jobs, and often, are homeless.

Unlike the Ben Massell Clinic, Mercy Care receives money from state and federal grants, including Medicaid, which is the social health care program for the poor and disabled. Under Obamacare, some government funding was expanded.

"We received about two and a half million dollars in new funding which helped us to buy a new clinic and offer more services to our existing clinics," says Andrews, adding that Mercy Care has also increased the number of patients by 30 percent over the past five years.

However, a new healthcare law could put an end to those funding streams. Mercy Care, like many other community-based organizations, is used to changing political climates, says Andrews. Quite often, when funding gets cut, private donors jump in and try to fill the void. Still, Andrews thinks healthcare for the poor should never be a charitable responsibility alone.

"I'm a firm believer that healthcare is a human right, and everybody should have access to basic services." He adds that many politicians who are trying to cut entitlement programs expect the community to take care of those people.

"But, there must be a balance," Andrews says. "The community will not be able to respond wholly. We will see a rise in the number of people without insurance, we will see a lot more people with chronic diseases."

The funding cuts could hit people like Derek. He's 55 and on Medicaid. He's a diabetic, and has been a patient at Mercy Care for two years.  He used to be a truck driver, tractor-trailer, he says with hint of pride in his smile.

"I would be sick a lot, and then I faded in and out of work," he continues. "I lost my job, I lost my insurance, and then it was problem after problem, just like that."

Since he has received continuous medical care he feels much better, he says, and he plans to look for a job again soon.

It's a story with a good ending, at least for the time being. And because they don't want Derek's story to be an exception, Tom Andrews and his team at Mercy Care already brace for the coming wave of underserved patients.

"We've recently purchased four acres of property adjacent to our main building," says Andrews. Mercy Care plans to expand its facility in order to meet the rising demand. "We need to be prepared for what will happen in the next couple of years as a result of any action to repeal and replace the Affordable Care Act."


This is the translation of a story originally published in German on deutschlandfunk.de, the online edition of German national public radio. © Katja Ridderbusch